Does Perineural Invasion on Prostate Biopsy Predict Adverse Prostatectomy Outcomes?
S Loeb, JI Epstein, EB Humphreys, PC Walsh. The Johns Hopkins Hospital, Baltimore
Background: There is conflicting evidence on the prognostic significance of perineural invasion in prostate needle biopsy specimens. Our objective was to determine the relationship between biopsy perineural invasion and radical prostatectomy outcomes in a contemporary radical prostatectomy series.
Design: From 2002 to 2007, 1256 men underwent radical prostatectomy by a single surgeon. Multivariable logistic regression and Cox proportional hazards models were used to examine the relationship between perineural invasion with pathological tumor features and biochemical progression, respectively, after adjustment for PSA, clinical stage, and biopsy Gleason score. Additional Cox models were performed to examine the relationship between nerve-sparing and biochemical progression among men with perineural invasion.
Results: Perineural invasion was found in 188 (15%) patients, and was significantly associated with aggressive pathology and biochemical progression in univariate analysis. On multivariate analysis, PNI was significantly associated with extra-prostatic extension, and seminal vesicle invasion (p<0.001), yet not lymph node metastases (p=0.059) and not positive margins (p=0.13). Biochemical progression occurred in 10.5% of patients with PNI, compared to 3.5% of those without PNI (unadjusted HR 3.12, 1.77-5.52, p<0.001). However, PNI was not a significant independent predictor (p=0.14) of biochemical progression on multivariate analysis when PSA (p<0.001) and biopsy Gleason score (p<0.001) were factored in. Clinical stage was also not a significant independent predictor. Finally, nerve-sparing did not adversely affect biochemical progression even among men with PNI.
Conclusions: PNI is an independent risk factor for aggressive pathology features, and a nonindependent risk factor for biochemical progression after radical prostatectomy. Our findings support the routine reporting of PNI in biopsy pathology reports.
Category: Genitourinary (including renal tumors)
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 107, Tuesday Afternoon