The prognostic significance of perineural invasion in prostatic cancer biopsies

Abstract

Men with clinically localized prostate cancer are faced with a wide range of treatment options, and only Gleason grading is universally used as a histopathological prognostic factor for this disease. The significance of perineural invasion in diagnostic biopsies is controversial. Opinion about whether or not it should influence treatment decisions is currently almost equally divided. To address this, the authors performed a systematic review of studies that examine the association between perineural invasion and prostate cancer recurrence. MEDLINE, Embase, and the Web of Knowledge were searched from January 1990 to December 2005.Outcomes analyzed were the development of biochemical or clinical recurrence. Twenty-one articles on the association of perineural invasion in biopsies and prostate cancer recurrence after radical prostatectomy (n ¼ 10) or radiotherapy (n ¼ 11) were found but none on its significance in the context of watchful waiting. Structured data extraction was performed to allow comparisons between articlesand to identify sources of heterogeneity to explain discrepancies in results. The considerable variation in study design, execution, and reporting precluded metaanalysis and quantitative risk estimation, but the weight of evidence suggested that perineural invasion in biopsies was a significant prognostic indicator, particularly in specific patient groups defined by presenting serum prostate-specific antigen levels and biopsy Gleason scores. Immediate treatment rather than watchful waiting may be more appropriate for patients with localized prostatic cancer and perineural invasion. However, the data are limited, and well-designed studies that use predefined stringent protocols are required to provide robust estimates of risk to aid in treatment planning.

The clinical management of patients with a small volume of prostatic cancer on biopsy: What are the risks of progression?

“…The previously described, 27 overarching, comprehensive search strategy to identify all articles relevant to prostate cancer and pathology was updated to the end of March 2007 and was extended to include Scopus in addition to MEDLINE, Embase, and the Web of Knowledge. To search for additional studies, hand searching of relevant journals was undertaken, and the reference lists of retrieved articles were scrutinized.…”

“…Structured data extraction was performed as described previously to define the study design and outcomes reporting 27 that allowed comparison between studies. Data specific to the question under scrutiny included the definition of microfocal carcinoma and the number of biopsy cores obtained, because the diagnosis of microfocal carcinoma may have different implications, depending on how extensively the prostate was sampled.…”

Can perineural invasion detected in prostate needle biopsy specimens predict surgical margin positivity in D’Amico low risk patients?

“…Although some authors have asserted that the detection of PNI in needle biopsy specimens might increase risk of extra-prostatic extension, this issue is still debatable. In their systematic review, Harnden et al (7) investigated the importance of the detection of PNI in cases with postoperative and postradiotherapeutic recurrences and demonstrated its significant prognostic value, especially in patient subgroups defined based on serum PSA levels and GS. They also indicated that patients whose biopsy specimens had evidence of PNI were not suitable for watchful waiting and they required early therapeutic intervention.…”

Prostate cancer with perineural spread and dural extension causing bilateral lumbosacral plexopathy: case report

“…In prostate cancer PNI is common and is seen in 7%-43% of biopsies 11 and in 77%-93% of prostatectomy specimens from patients in whom previous biopsy was positive for PNI. 4,13 Its prognostic value is still controversial, but in more recent studies primarily focused on PNI, it appears to be an independent prognostic factor associated with decreased survival and increased recurrence rate.…”