Impact of Autonomic Nerve Invasion on Biochemical Recurrence for Intermediate Risk T3a Prostate Cancer With Negative...

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Radical prostatectomy (RP) is a primary treatment for prostate cancer.
• Extraprostatic spread (EPS) with negative margins presents a challenge in predicting outcomes.
• Autonomic nerve invasion (ANI) is a potential prognostic factor in prostate cancer.

Purpose of the Study:

• To evaluate the impact of autonomic nerve invasion (ANI) on biochemical recurrence (BCR) or early adjuvant therapy.
• To assess the prognostic value of ANI in patients with extraprostatic spread (EPS) and negative margins post-radical prostatectomy (RP).

Main Methods:

• Retrospective analysis of 218 men with T3a prostate cancer and negative margins who underwent RP.
• Statistical evaluation using t-tests, chi-square tests, Kaplan-Meier analysis, and Cox proportional hazard regression.
• Internal validation for model calibration.

Main Results:

• Patients with ANI showed a significantly higher incidence of BCR or early adjuvant therapy (HR 1.94, P=.02).
• ANI was a significant independent predictor of BCR/early adjuvant therapy in intermediate-risk (Gleason score 7/ISUP grades 2-3) disease (HR 3.03, P=.01).
• ANI did not independently predict outcomes in high-risk (Gleason score ≥8/ISUP grades 4-5) disease.

Conclusions:

• Autonomic nerve invasion (ANI) independently predicts worse outcomes in intermediate-risk T3a prostate cancer with negative margins.
• ANI is not an independent predictor for high-risk T3a prostate cancer.
• ANI offers a cost-effective method for risk stratification in specific prostate cancer patient groups.