Perineural invasion and risk for progression in localized and locally advanced disease


A new study by an Austrian research team has further helped to clarify the potential prognostic significance of perineural invasion as a risk factor in the progression of localized and locally advanced forms of prostate cancer.

Aumayr et al. carried out a highly detailed pathological examination of prostate specimens from 88 patients, all of whom had received a radical prostatectomy and were shown to have a post-surgical pathologic grade of pT3aN0M0. In this study, the authors carefully counted the numbers of nerves infiltrated by cancer in each transverse pathologic section of each totally embedded prostate specimen.

The results of this pathologic examination showed the following:

  • 87/88 patients (98.9 percent) included in the study showed signs of penineural invasion (PNI).
    • 54/87 patients had PNI that was confined to the prostate.
    • 33/87 patients had PNI that had spread to extraprostatic nerves.
  • Extraprostatic but not intraprostatic PNI was found significantly more often in tumors of higher Gleason score.
  • The intraprostatic number of infiltrated nerves (NIN) correlated with the extraprostatic NIN.
  • There was no association between the intraprostatic NIN or the extraprostatic NIN and Gleason score, lymph node invasion, or blood vessel invasion.
  • An extraprostatic NIN of ≤10 extended biochemical progression-free survival in univariate analysis.
    • When biochemical failure was assessed as a PSA level of 0.2 ng/ml, the extraprostatic NIN of ≤10 was a significant indicator of progression-free survival (P = 0.002).
    • When biochemical failure was assessed as a PSA level of 0.4 ng/ml, the extraprostatic NIN of ≤10 was a very highly significant indicator of progression-free survival (P < 0.000001).
  • When biochemical failure was assessed as a PSA level of 0.4 ng/ml, the extraprostatic NIN of ≤10 was a significant indicator of progression-free survival in multivariate analysis (P = 0.039).

The authors conclude that a high level of extraprostatic NIN correlates with high risk for tumor progression and seems to be an independent prognostic parameter.

This study would also seem to correlate with prior suggestions that — for men with truly localized prostate cancer — the presence of intraprostatic PNI is not, on its own, a significant prognostic indicator of risk for more aggressive disease.

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