Perineural invasion in radical prostatectomy specimens: lack of prognostic significance

The prognostic significance of perineural invasion in radical prostatectomy specimens is uncertain. We evaluated the relationship between perineural invasion and other pathological characteristics in whole mount radical retropubic prostatectomy specimens as well as prostate specific antigen (PSA) recurrence postoperatively.

Between 1999 and 2003, 364 consecutive patients were treated with radical prostatectomy for localized prostate cancer. Radical prostatectomy specimens were processed by the whole mount technique. The relationship of perineural invasion and various clinicopathological characteristics to PSA recurrence was analyzed.

Perineural invasion was present in 287 specimens (79%). Specimens with perineural invasion were associated with smaller prostate weight (p <0.0001), greater pathological stage (p <0.0001), larger tumor volume (p <0.0001), higher Gleason score (p <0.0001), a higher incidence of extraprostatic extension (p <0.0001) and seminal vesicle invasion (p = 0.02), and a higher positive surgical margin rate (p = 0.01). Perineural invasion did not correlate with preoperative PSA (p = 0.96), lymph node metastases (p = 0.35), multifocality (p = 0.21), high grade prostatic intraepithelial neoplasia (p = 0.12) or PSA recurrence (p = 0.24).

While perineural invasion in the radical prostatectomy specimen significantly correlated with multiple adverse pathological factors, it did not predict which patients will have early PSA recurrence following radical prostatectomy.