https://doi.org/10.4081/aiua.2020.4.330

Perineural invasion in prostate needle biopsy: Prognostic value on radical prostatectomy and active surveillance

Vol. 92 No. 4 (2020)
Submitted: July 22, 2020
Accepted: September 3, 2020
Published: December 18, 2020
Prostate Cancer, Active Surveillance, Prostatectomy
Abstract Views: 1293
PDF: 667
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Nuno Ramos
nunoandre33@gmail.com
http://orcid.org/0000-0001-8024-4547
Urology Department, Garcia de Orta Hospital, Almada, Portugal.
Alexandre Macedo
Urology Department, Garcia de Orta Hospital, Almada, Portugal.
João Rosa
Urology Department, Garcia de Orta Hospital, Almada, Portugal.
Miguel Carvalho
Urology Department, Garcia de Orta Hospital, Almada, Portugal.

Purpose: The aim of this study was to evaluate the clinical impact of perineural invasion (PNI) in prostate biopsy in patients submitted to radical prostatectomy and on active surveillance (AS). Materials and methods: We performed a single center, retrospective, cohort study on patients diagnosed with clinically localized prostate cancer and submitted to radical prostatectomy between January 2010 and December 2016. We evaluated clinical and anatomopathological characteristics from the biopsy and radical prostatectomy specimen and correlated with biochemical recurrence (BCR) using a survival analysis. We also evaluated the impact of PNI in patients with criteria for active surveillance. Results: The cohort analyzed consists of 107 patients, with a mean age of 63.1 years and a mean PSA prior to biopsy of 7.8 ng/ml. In prostate biopsy, 66.4% of the patients had a Gleason score of 6, 30.9% had a Gleason score of 7, and 2.7% had a Gleason score of 8 or higher, with PNI being detected in 57 (53.3%) of the patients. Regarding the anatomopathological characteristics of the surgical specimen, invasion of the seminal vesicles was observed in 6.5%, lymph nodes involvement in 9.3% and positive surgical margins in 27.1% of the cases. During follow-up, BCR was recorded in 24.3% of cases. Clinicopathological features were stratified according to the presence or absence of PNI, with statistical significance in relation to the Gleason Score (p = 0.001), pathologic T stage (p = 0.001), D’Amico risk (p = 0.002) and upstaging of the Gleason score (p = 0.045). The survival analysis revealed a relationship between PNI and BCR (hazard ratio = 2.98; 95% CI: 1.36-6.58; p = 0.007). Regarding the men potentially eligible for AS, the presence of PNI on the biopsy presented a significant relation with Gleason upgrade (p = 0.004) and extraprostatic extension (p = 0.017). Conclusions: The presence of PNI in prostate biopsy is related to adverse anatomopathological factors, being a potential predictor of BCR and have a possible role in the selection of patients for AS.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Zhang LJ, Wu B, Zha ZL, Qu W, Zhao H, Yuan J, Feng YJ: Perineural invasion as an independent predictor of biochemical recurrence in prostate cancer following radical prostatectomy or radiotherapy: a systematic review and meta-analysis. BMC Urol 2018, 18(1):5. DOI: https://doi.org/10.1186/s12894-018-0319-6
Ahmad AS, Parameshwaran V, Beltran L, Fisher G, North BV, Greenberg D, Soosay G, Moller H, Scardino P, Cuzick J et al: Should reporting of peri-neural invasion and extra prostatic extension be mandatory in prostate cancer biopsies? correlation with outcome in biopsy cases treated conservatively. Oncotarget 2018, 9(29):20555-20562. DOI: https://doi.org/10.18632/oncotarget.24994
Vargas SO, Jiroutek M, Welch WR, Nucci MR, D'Amico AV, Renshaw AA: Perineural invasion in prostate needle biopsy specimens. Correlation with extraprostatic extension at resection. Am J Clin Pathol 1999, 111(2):223-228. DOI: https://doi.org/10.1093/ajcp/111.2.223
Celik S, Bozkurt O, Demir O, Gurboga O, Tuna B, Yorukoglu K, Aslan G: Effects of perineural invasion in prostate needle biopsy on tumor grade and biochemical recurrence rates after radical prostatectomy. Kaohsiung J Med Sci 2018, 34(7):385-390. DOI: https://doi.org/10.1016/j.kjms.2017.12.014
Erdem S, Verep S, Bagbudar S, Ozluk Y, Sanli O, Ozcan F: The clinical predictive factors and postoperative histopathological parameters associated with upgrading after radical prostatectomy: A contemporary analysis with grade groups. Prostate 2020, 80(2):225-234. DOI: https://doi.org/10.1002/pros.23936
Jeon HG, Bae J, Yi JS, Hwang IS, Lee SE, Lee E: Perineural invasion is a prognostic factor for biochemical failure after radical prostatectomy. Int J Urol 2009, 16(8):682-686. DOI: https://doi.org/10.1111/j.1442-2042.2009.02331.x
Barsky AR, Kraus RD, Carmona R, Santos PMG, Li C, Schwartz LE, Ballas LK, Vapiwala N: Investigating association of perineural invasion on prostate biopsy with Gleason score upgrading at prostatectomy: A multi-institutional analysis. Cancer Med 2020, 9(10):3383-3389. DOI: https://doi.org/10.1002/cam4.2920
Verep S, Erdem S, Ozluk Y, Kilicaslan I, Sanli O, Ozcan F: The pathological upgrading after radical prostatectomy in low-risk prostate cancer patients who are eligible for active surveillance: How safe is it to depend on bioptic pathology? Prostate 2019, 79(13):1523-1529. DOI: https://doi.org/10.1002/pros.23873
Ediz C, Akan S, Temel MC, Yilmaz O: The importance of PSA-Density in active surveillance for prostate cancer. Arch Ital Urol Androl 2020, 92(2). DOI: https://doi.org/10.4081/aiua.2020.2.136
Kraus RD, Barsky A, Ji L, Garcia Santos PM, Cheng N, Groshen S, Vapiwala N, Ballas LK: The Perineural Invasion Paradox: Is Perineural Invasion an Independent Prognostic Indicator of Biochemical Recurrence Risk in Patients With pT2N0R0 Prostate Cancer? A Multi-Institutional Study. Adv Radiat Oncol 2019, 4(1):96-102. DOI: https://doi.org/10.1016/j.adro.2018.09.006
Turner RM, 2nd, Yecies TS, Yabes JG, Ristau BT, Woldemichael E, Davies BJ, Jacobs BL, Nelson JB: Biopsy Perineural Invasion in Prostate Cancer Patients Who Are Candidates for Active Surveillance by Strict and Expanded Criteria. Urology 2017, 102:173-177. DOI: https://doi.org/10.1016/j.urology.2016.11.011
Strom P, Nordstrom T, Delahunt B, Samaratunga H, Gronberg H, Egevad L, Eklund M: Prognostic value of perineural invasion in prostate needle biopsies: a population-based study of patients treated by radical prostatectomy. J Clin Pathol 2020. DOI: https://doi.org/10.1136/jclinpath-2019-206300
Zhao J, Chen J, Zhang M, Tang X, Sun G, Zhu S, Liu J, Zhang H, Zhang X, Yin X et al: The clinical significance of perineural invasion in patients with de novo metastatic prostate cancer. Andrology 2019, 7(2):184-192. DOI: https://doi.org/10.1111/andr.12578
Zareba P, Flavin R, Isikbay M, Rider JR, Gerke TA, Finn S, Pettersson A, Giunchi F, Unger RH, Tinianow AM et al: Perineural Invasion and Risk of Lethal Prostate Cancer. Cancer Epidemiol Biomarkers Prev 2017, 26(5):719-726. DOI: https://doi.org/10.1158/1055-9965.EPI-16-0237
Kuang AG, Nickel JC, Andriole GL, Castro-Santamaria R, Freedland SJ, Moreira DM: Both acute and chronic inflammation are associated with less perineural invasion in men with prostate cancer on repeat biopsy. BJU Int 2019, 123(1):91-97. DOI: https://doi.org/10.1111/bju.14428
Wu S, Lin X, Lin SX, Lu M, Deng T, Wang Z, Olumi AF, Dahl DM, Wang D, Blute ML et al: Impact of biopsy perineural invasion on the outcomes of patients who underwent radical prostatectomy: a systematic review and meta-analysis. Scand J Urol 2019, 53(5):287-294. DOI: https://doi.org/10.1080/21681805.2019.1643913
Camur E, Coskun A, Kavukoglu, Can U, Kara O, Develi Camur A, Sarica K, Narter KF: Prostate volume effect on Gleason score upgrading in active surveillance appropriate patients. Arch Ital Urol Androl 2019, 91(2). DOI: https://doi.org/10.4081/aiua.2019.2.93
Ravery V, Boccon-Gibod LA, Dauge-Geffroy MC, Billebaud T, Delmas V, Meulemans A, Toublanc M, Boccon-Gibod L: Systematic biopsies accurately predict extracapsular extension of prostate cancer and persistent/recurrent detectable PSA after radical prostatectomy. Urology 1994, 44(3):371-376. DOI: https://doi.org/10.1016/S0090-4295(94)80095-2
Peng LC, Narang AK, Gergis C, Radwan NA, Han P, Marciscano AE, Robertson SP, He P, Trieu J, Ram AN et al: Effects of perineural invasion on biochemical recurrence and prostate cancer-specific survival in patients treated with definitive external beam radiotherapy. Urol Oncol 2018, 36(6):309 e307-309 e314. DOI: https://doi.org/10.1016/j.urolonc.2018.02.008
Kang M, Oh JJ, Lee S, Hong SK, Lee SE, Byun SS: Perineural Invasion and Lymphovascular Invasion are Associated with Increased Risk of Biochemical Recurrence in Patients Undergoing Radical Prostatectomy. Ann Surg Oncol 2016, 23(8):2699-2706. DOI: https://doi.org/10.1245/s10434-016-5153-z
Wong WW, Schild SE, Vora SA, Halyard MY: Association of percent positive prostate biopsies and perineural invasion with biochemical outcome after external beam radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2004, 60(1):24-29. DOI: https://doi.org/10.1016/j.ijrobp.2004.02.031
Yu HH, Song DY, Tsai YY, Thompson T, Frassica DA, DeWeese TL: Perineural invasion affects biochemical recurrence-free survival in patients with prostate cancer treated with definitive external beam radiotherapy. Urology 2007, 70(1):111-116. DOI: https://doi.org/10.1016/j.urology.2007.03.020
Reeves F, Hovens CM, Harewood L, Battye S, Peters JS, Costello AJ, Corcoran NM: Does perineural invasion in a radical prostatectomy specimen predict biochemical recurrence in men with prostate cancer? Can Urol Assoc J 2015, 9(5-6):E252-255. DOI: https://doi.org/10.5489/cuaj.2619
Freedland SJ, Csathy GS, Dorey F, Aronson WJ: Percent prostate needle biopsy tissue with cancer is more predictive of biochemical failure or adverse pathology after radical prostatectomy than prostate specific antigen or Gleason score. The Journal of urology 2002, 167(2 Pt 1):516-520. DOI: https://doi.org/10.1016/S0022-5347(01)69076-1
Trpkov C, Yilmaz A, Trpkov K: Perineural invasion in prostate cancer patients who are potential candidates for active surveillance: validation study. Urology 2014, 84(1):149-152. DOI: https://doi.org/10.1016/j.urology.2014.04.007
D'Amico AV, Wu Y, Chen MH, Nash M, Renshaw AA, Richie JP: Perineural invasion as a predictor of biochemical outcome following radical prostatectomy for select men with clinically localized prostate cancer. J Urol 2001, 165(1):126-129. DOI: https://doi.org/10.1097/00005392-200101000-00031
Quinn DI, Henshall SM, Brenner PC, Kooner R, Golovsky D, O'Neill GF, Turner JJ, Delprado W, Grygiel JJ, Sutherland RL et al: Prognostic significance of preoperative factors in localized prostate carcinoma treated with radical prostatectomy: importance of percentage of biopsies that contain tumor and the presence of biopsy perineural invasion. Cancer 2003, 97(8):1884-1893. DOI: https://doi.org/10.1002/cncr.11263
Maru N, Ohori M, Kattan MW, Scardino PT, Wheeler TM: Prognostic significance of the diameter of perineural invasion in radical prostatectomy specimens. Hum Pathol 2001, 32(8):828-833. DOI: https://doi.org/10.1053/hupa.2001.26456
Moreira DM, Fleshner NE, Freedland SJ: Baseline Perineural Invasion is Associated with Shorter Time to Progression in Men with Prostate Cancer Undergoing Active Surveillance: Results from the REDEEM Study. J Urol 2015, 194(5):1258-1263. DOI: https://doi.org/10.1016/j.juro.2015.04.113
Cohn JA, Dangle PP, Wang CE, Brendler CB, Novakovic KR, McGuire MS, Helfand BT: The prognostic significance of perineural invasion and race in men considering active surveillance. BJU Int 2014, 114(1):75-80. DOI: https://doi.org/10.1111/bju.12463

How to Cite

Ramos, N., Macedo, A., Rosa, J. ., & Carvalho, M. (2020). Perineural invasion in prostate needle biopsy: Prognostic value on radical prostatectomy and active surveillance. Archivio Italiano Di Urologia E Andrologia, 92(4). https://doi.org/10.4081/aiua.2020.4.330

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.