The prognostic significance of perineural invasion — redux

About 7 months ago we commented on an Italian study of the association between perineural invasion (PNI) on biopsy and outcomes after first-line surgical treatment for localized prostate cancer. That study suggested that a finding of PNI on biopsy had limited significance when it came to the patients’ surgical outcomes for patients with organ-confined disease.

A new article just published by a group of Korean researchers appears to further endorse the limited significance of PNI as an independent indicator of risk for progressive disease.

Lee et al. conducted a retsrospective analysis of data from 361 prostate cancer patients who received primary surgical treatment between 1999 and 2010 but were given no neoadjuvant therapy prior to surgery from 1999 to 2010. They examined whole-mount pathologica sections of surgical specimens from all patients who underwent radical prostatectomy.

The results of their study showed that:

  • PNI was observed in prostatectomy specimens from 188/361 patients (52.1 percent).
  • PNI in the prostatectomy specimen was significantly associated with the primary Gleason grade, the number of positive biopsy cores, and the percentage of tumor cells in positive biopsy cores.
  • PNI in the prostatectomy specimen was not significantly associated  with PNI on prostate biopsy.
  • PNI in the prostatectomy specimen was not an independent prognostic factor of biochemical recurrence or of cancer-specific survival.

The authors conclude that the presence of PNI in the prostatectomy specimen was significantly related to biologically aggressive tumor patterns but was not a prognostic factor for biochemical recurrence or cancer-specific survival in patients with prostate cancer.

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