Does perineural invasion on prostate biopsy predict adverse prostatectomy outcomes?

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Perineural invasion (PNI) on prostate biopsy has conflicting evidence regarding its prognostic significance.
• Understanding PNI's role in radical prostatectomy (RP) outcomes is crucial for patient management.

Purpose of the Study:

• To determine the relationship between perineural invasion (PNI) on prostate biopsy and outcomes following radical prostatectomy (RP).
• To evaluate the impact of nerve-sparing surgery on biochemical progression in patients with PNI.

Main Methods:

• Analysis of 1256 men undergoing RP by a single surgeon between 2002-2007.
• Multivariable logistic regression and Cox proportional hazards models were used to assess PNI's association with pathological features and biochemical progression.
• Cox models also examined the effect of nerve-sparing surgery on biochemical progression in men with PNI.

Main Results:

• PNI was identified in 15% of patients and correlated with aggressive pathology, including extraprostatic extension and seminal vesicle invasion.
• Biochemical progression occurred more frequently in patients with PNI (10.5%) versus those without (3.5%) on unadjusted analysis.
• PNI was not an independent predictor of biochemical progression on multivariate analysis, and nerve-sparing surgery did not negatively impact outcomes in men with PNI.

Conclusions:

• PNI is an independent risk factor for aggressive pathological features but a non-independent risk factor for biochemical progression post-RP.
• Bilateral nerve-sparing surgery in radical prostatectomy does not compromise oncological outcomes for patients with PNI on biopsy.