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PATHOLOGY
Does
perineural invasion on prostate biopsy predict adverse prostatectomy outcomes?
Loeb S, Epstein JI, Humphreys EB, Walsh PC
James Buchanan Brady Urological Institute and the Department of Urology,
Johns Hopkins Medical Institutions, Baltimore, MD, USA
BJU Int. 2009 Aug 19. [Epub ahead of print]
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Objective:
To determine the relationship between perineural invasion (PNI) on
prostate biopsy and radical prostatectomy (RP) outcomes in a contemporary
RP series, as there is conflicting evidence on the prognostic significance
of PNI in prostate needle biopsy specimens.
Patients and Methods: From 2002 to 2007, 1256 men had RP by one surgeon.
Multivariable logistic regression and Cox proportional hazards models
were used to examine the relationship of PNI with pathological tumour
features and biochemical progression, respectively, after adjusting
for prostate-specific antigen level, clinical stage and biopsy Gleason
score. Additional Cox models were used to examine the relationship
between nerve-sparing and biochemical progression among men with PNI.
Results: PNI was found in 188 (15%) patients, and was significantly
associated with aggressive pathology and biochemical progression.
On multivariate analysis, PNI was significantly associated with extraprostatic
extension and seminal vesicle invasion (P < 0.001). Biochemical
progression occurred in 10.5% of patients with PNI, vs 3.5% of those
without PNI (unadjusted hazard ratio 3.12, 95% confidence interval
1.77-5.52, P < 0.001). However, PNI was not a significant independent
predictor of biochemical progression on multivariate analysis. Finally,
nerve-sparing did not adversely affect biochemical progression even
among men with PNI.
Conclusion: PNI is an independent risk factor for aggressive pathology
features and a non-independent risk factor for biochemical progression
after RP. However, bilateral nerve-sparing surgery did not compromise
the oncological outcomes for patients with PNI on biopsy.
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Editorial
Comment
The significance of perineural invasion by carcinoma in needle prostatic
biopsies is controversial (1,2). Presence of perineural invasion in
needle prostatic biopsies may influence the indication of resection
of neurovascular bundle. Loeb’s et al. study showed that perineural
invasion on prostate biopsy was not a significant independent predictor
of biochemical progression on multivariate analysis and nerve-sparing
surgery did not adversely affect biochemical progression even among
men with perineural invasion.
In a recent study, we found that perineural invasion in needle prostatic
biopsies significantly predicted prostatectomy stage > pT2 in univariate
(p < 0.01) but not in multivariate analysis (p = 0.38). In multivariate
analysis preoperative PSA, Gleason grading and percentage of linear
extent of cancer in mm in the needle biopsy were the significant variables
predictive of > pT2.
We agree with Loeb’s et al. conclusion that nerve-sparing surgery
does not adversely affect biochemical progression even among men with
perineural invasion.
References
- Bastacky
SI, Walsh PC, Epstein JI: Relationship between perineural tumor invasion
on needle biopsy and radical prostatectomy capsular penetration in clinical
stage B adenocarcinoma of the prostate. Am J Surg Pathol. 1993; 17:
336-41.
- Egan AJM,
Bostwick DG: Prediction of extraprostatic extension of prostate cancer
based on needle biopsy findings: Perineural invasion lacks significance
on multivariate analysis. Am J Surg Pathol. 1997; 21: 1496-500.
Dr.
Athanase Billis
Full-Professor of Pathology
State University of Campinas, Unicamp
Campinas, São Paulo, Brazil
E-mail: athanase@fcm.unicamp.br
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