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Karsiyakali N, Bulent Ozgen M, Ozveren B, Akbal C, Dincer A, Durak H, Turkeri L. The association between perineural invasion in mpMRI-targeted and/or systematic prostate biopsy and adverse pathological outcomes in robot-assisted radical prostatectomy. Actas Urol Esp 2022; 46:377-384. [PMID: 35260369 DOI: 10.1016/j.acuroe.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/27/2021] [Accepted: 09/05/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES This study aims to investigate the relationship between perineural invasion (PNI) in targeted (TBx) and/or systematic (SBx) prostate needle biopsy and adverse pathological features of prostate cancer (PCa) in prostatectomy specimens. MATERIALS AND METHODS A total of 95 male patients who underwent transperineal TBx and/or concomitant SBx subsequently treated with robot-assisted radical prostatectomy for PCa between October 2015 and June 2020 were included. The performance of PNI as a classification test (sensitivity, specificity, positive and negative predictive values) and its correlation with clinically significant PCa, surgical margin positivity, extraprostatic extension, and seminal vesicle invasion in prostatectomy were computed. RESULTS The median age of the patients was 65 (60-70) years. TBx and concomitant SBx were performed in 78 (82.1%) patients, while 16 (16.8%) patients underwent SBx alone and one (1.1%) patient underwent TBx alone. The frequency of PNI in TBx and SBx was 17 (21.5%) and 32 (34.0%), respectively. The specificity/negative predictive values of PNI for surgical margin positivity, extraprostatic extension, and seminal vesicle invasion were 79.7/88.7%, 92.5/79.0%, and 83.3/96.8%, in TBx, and 71.1/87.1%, 80.7/74.2%, and 69.5/91.9%, in SBx, respectively. There was also a statistically significant correlation between PNI in biopsy and surgical margin positivity, extraprostatic extension, and seminal vesicle invasion in prostatectomy as well as the ISUP grade group and pT stage. CONCLUSIONS The absence of PNI in prostate needle biopsy may predict localized PCa with a pT stage ≤ 2c and negative surgical margins in contrast to its presence which appears to be an indicator of unfavorable factors in final pathology.
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Affiliation(s)
- N Karsiyakali
- Department of Urology, Altunizade Hospital, Acibadem M. A. Aydinlar University, Istanbul, Turkey.
| | - M Bulent Ozgen
- Department of Urology, Altunizade Hospital, Acibadem M. A. Aydinlar University, Istanbul, Turkey
| | - B Ozveren
- Department of Urology, Altunizade Hospital, School of Medicine, Acibadem M. A. Aydinlar University, Istanbul, Turkey
| | - C Akbal
- Department of Urology, Altunizade Hospital, School of Medicine, Acibadem M. A. Aydinlar University, Istanbul, Turkey
| | - A Dincer
- Department of Radiology, Altunizade Hospital, School of Medicine, Acibadem M. A. Aydinlar University, Istanbul, Turkey
| | - H Durak
- Clinical Pathology Laboratory, Altunizade Hospital, Acibadem M. A. Aydinlar University, Istanbul, Turkey
| | - L Turkeri
- Department of Urology, Altunizade Hospital, Acibadem M. A. Aydinlar University, Istanbul, Turkey
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Karsiyakali N, Bulent Ozgen M, Ozveren B, Akbal C, Dincer A, Durak H, Turkeri L. Asociación entre la invasión perineural en la biopsia de próstata dirigida por RMmp y/o sistemática y los resultados patológicos adversos en la prostatectomía radical asistida por robot. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Li H, Chang X, Du Y. Perineural invasion detected in prostate biopsy is a predictor of positive surgical margin of radical prostatectomy specimen: A meta-analysis. Andrologia 2022; 54:e14395. [PMID: 35233813 DOI: 10.1111/and.14395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/26/2022] [Accepted: 01/30/2022] [Indexed: 11/27/2022] Open
Abstract
The role of perineural invasion detected by puncture biopsy of prostate cancer remains controversial. We performed a meta-analysis to assess the relationship between positive perineural invasion at prostate biopsy and positive surgical margins (PSM) after radical prostatectomy. We searched a number of relevant electronic databases including Web of Science, Medline, PubMed, Embase, and the Cochrane Library until 31 March 2021. STATA 15.1 software was used to analyse all data for this article. The quality of these studies was assessed by the Newcastle-Ottawa Scale (ranged from 0 to 9 stars). Finally, we selected 13 high-quality studies in our meta-analysis, which contain 8283 patients. Overall pooled analysis proposed that biopsy perineural invasion was related to a higher risk of the positive surgical margins after radical prostatectomy in prostate cancer (RR: 1.73; 95% CI: 1.56-1.92; z = 10.30, p = 0.000). Moreover, the outcomes of the publication bias checkout testified that without significant bias arose (Egger's test: 0.086 > 0.05; Begg's test: 0.59 > 0.05). The existing evidence indicates that higher incidence of positive surgical margins in patients who had perineural invasion was detected in prostate biopsy.
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Affiliation(s)
- Hui Li
- Department of Urology, Fuyang People's Hospital, Fuyang, China
| | - Xuefeng Chang
- Fuyang People's Hospital, Anhui Medical University, Fuyang, China
| | - Yongqiang Du
- Fuyang People's Hospital, Anhui Medical University, Fuyang, China
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Vukovic M, Kavaric P, Magdelinic A, Nikomanis P, Tomovic S, Pelicic D. Perineural invasion on biopsy specimen as predictor of tumor progression in aging male treated with radical prostatectomy. Could we use it for pre-surgical screening? Aging Male 2020; 23:720-725. [PMID: 30843451 DOI: 10.1080/13685538.2019.1581758] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
We aimed to analyze the correlation of perineural invasion on transrectal ultrasound guided prostate biopsy with predictors of biochemical cancer recurrence, as well as its impact on clinical outcomes, for non-metastatic prostate cancer. For the study, patients with perineural invasion (N = 86) were recruited into group I and underwent open retropubic prostatectomy, regardless of clinical stage; cases with prostate cancer but without perineural invasion on biopsy, who received radical prostatectomy as the treatment modality, were placed into group II (n = 90). Perineural invasion was detected preoperatively in 43% of cases that revealed surgical margin positivity postoperatively, while 85% of the remaining cases (group II) had negative surgical margins. There was no correlation on prostate biopsy between perineural invasion and Gleason score or PSA, based on Sperman's rank-order correlation analysis. However, there was strong positive correlation of perineural invasion with clinical stage and patients age. Additionaly, we demonstrated that perineural invasion on biopsy is a non-independent risk factor for metastatic occurrence, although the correlation was significant in univariate analysis. Nevertheless, we found strong correlation between invasion on initial biopsy specimen with biochemical cancer recurrence, suggesting that perineural invasion on prostate biopsy is a significant predictor of worse prognostic outcome.
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Affiliation(s)
- M Vukovic
- Urology Clinic, Clinical centre of Montenegro, Podgorica, Montenegro
| | - P Kavaric
- Urology Clinic, Clinical centre of Montenegro, Podgorica, Montenegro
| | - A Magdelinic
- Urology Clinic, Clinical centre of Montenegro, Podgorica, Montenegro
| | - P Nikomanis
- Department of Intensive care, SLK-Kliniken, Heilbronn, Germany
| | - S Tomovic
- Faculty of Mathematics and Natural Sciences, University of Montenegro, Podgorica, Montenegro
| | - D Pelicic
- Center for science, Clinical cente of Montenegro, Podgorica, Montenegro
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Ahmad AS, Parameshwaran V, Beltran L, Fisher G, North BV, Greenberg D, Soosay G, Møller H, Scardino P, Cuzick J, Berney DM. Should reporting of peri-neural invasion and extra prostatic extension be mandatory in prostate cancer biopsies? correlation with outcome in biopsy cases treated conservatively. Oncotarget 2018; 9:20555-20562. [PMID: 29755671 PMCID: PMC5945501 DOI: 10.18632/oncotarget.24994] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 03/15/2018] [Indexed: 11/25/2022] Open
Abstract
The identification of perineural invasion (PNI) and extraprostatic extension (ECE) in prostate cancer (PC) biopsies is time consuming and can be difficult. Although this is required information in many datasets, there is little evidence on their effect on outcome in patients treated conservatively. Cases of PC were identified from three cancer registries in the UK from men with clinically localized prostate cancer diagnosed by needle biopsy from 1990-2003. The endpoint was prostate cancer death (DOD). Patients treated radically within 6 months, those with objective evidence of metastases or who had prior hormone therapy were excluded. Follow-up was through cancer registries up until 2012. Deaths were divided into those from PC and those from other causes, according to WHO criteria. 988 biopsy cases (6522 biopsy cores) were centrally reviewed by three uropathologists and assigned a Gleason score and Grade Group (GG). The presence of both PNI and ECE was recorded. Of 988 patients, PNI was present in 288 (DOD = 75) and ECE in 23 (DOD = 5). On univariable analysis PNI was highly significantly associated with DOD (hazard ratio [HR] 2.28, 95% CI: 1.68, 3.1, log-rank test p-value = 4.8 × 10-8), but ECE was not (log-rank test p-value = 0.334). On multivariable analysis with GG, serum PSA (per 10%), clinical stage and extent of disease (per 10%), PNI lost significance (HR 1.16, 95% CI: 0.83, 1.63, likelihood ratio test p-value = 0.371). The utility of routinely examining prostate biopsies for ECE and PNI is doubtful as it is not independently associated with higher grade, stage or prognosis.
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Affiliation(s)
- Amar S. Ahmad
- UK Center for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Vishnu Parameshwaran
- Department of Molecular Oncology, Barts Cancer Institute Queen Mary University of London, London, UK
| | - Luis Beltran
- Department of Molecular Oncology, Barts Cancer Institute Queen Mary University of London, London, UK
| | - Gabrielle Fisher
- UK Center for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Bernard V. North
- UK Center for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - David Greenberg
- National Cancer Registration Service (Eastern Office), Public Health England, Cambridge, UK
| | | | - Henrik Møller
- Cancer Epidemiology and Population Health, King's College London, London, UK
| | - Peter Scardino
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Jack Cuzick
- UK Center for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Daniel M. Berney
- Department of Molecular Oncology, Barts Cancer Institute Queen Mary University of London, London, UK
| | - on behalf of the Transatlantic Prostate Group
- UK Center for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
- Department of Molecular Oncology, Barts Cancer Institute Queen Mary University of London, London, UK
- National Cancer Registration Service (Eastern Office), Public Health England, Cambridge, UK
- Department of Pathology, Queen’s Hospital, Romford, Essex, UK
- Cancer Epidemiology and Population Health, King's College London, London, UK
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Zhang LJ, Wu B, Zha ZL, Qu W, Zhao H, Yuan J, Feng YJ. Perineural invasion as an independent predictor of biochemical recurrence in prostate cancer following radical prostatectomy or radiotherapy: a systematic review and meta-analysis. BMC Urol 2018; 18:5. [PMID: 29390991 PMCID: PMC5796578 DOI: 10.1186/s12894-018-0319-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/23/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although numerous studies have shown that perineural invasion (PNI) is linked to prostate cancer (PCa) risk, the results have been inconsistent. This study aimed to explore the association between PNI and biochemical recurrence (BCR) in patients with PCa following radical prostatectomy (RP) or radiotherapy (RT). METHODS According to the PRISMA statement, we searched the PubMed, EMBASE, Chinese National Knowledge Infrastructure (CNKI) and Wan Fang databases from inception to May 2017. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were extracted from eligible studies. Fixed or random effects model were used to calculate pooled HRs and 95% CIs according to heterogeneity. Publication bias was calculated by Begg's test. RESULTS Ultimately, 19 cohort studies that met the eligibility criteria and that involved 13,412 patients (82-2,316 per study) were included in this meta-analysis. The results showed that PNI was associated with higher BCR rates in patients with PCa after RP (HR=1.23, 95% CI: 1.11, 1.36, p<0.001) or RT (HR=1.22, 95% CI: 1.12, 1.34, p<0.001). No potential publication bias was found among the included studies in the RP group (p-Begg = 0.124) or the RT group (p-Begg = 0.081). CONCLUSIONS This study suggests that the presence of PNI by histopathology is associated with higher risk of BCR in PCa following RP or RT, and could serve as an independent prognostic factor in patients with PCa.
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Affiliation(s)
- Li-Jin Zhang
- Departments of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China.
| | - Bin Wu
- Departments of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
| | - Zhen-Lei Zha
- Departments of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
| | - Wei Qu
- Departments of Pharmacy, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
| | - Hu Zhao
- Departments of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
| | - Jun Yuan
- Departments of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
| | - Ye-Jun Feng
- Departments of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
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Celik S, Bozkurt O, Demir O, Gurboga O, Tuna B, Yorukoglu K, Aslan G. Effects of perineural invasion in prostate needle biopsy on tumor grade and biochemical recurrence rates after radical prostatectomy. Kaohsiung J Med Sci 2018; 34:385-390. [PMID: 30063011 DOI: 10.1016/j.kjms.2017.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/14/2017] [Accepted: 12/28/2017] [Indexed: 10/18/2022] Open
Abstract
To predict local invasive disease before retropubic radical prostatectomy (RRP), the correlation of perineural invasion (PNI) on prostate needle biopsy (PNB) and RRP pathology data and the effect of PNI on biochemical recurrence (BR) were researched. For patients with RRP performed between 2005 and 2014, predictive and pathologic prognostic factors were assessed. Initially all and D'Amico intermediate-risk group patients were comparatively assessed in terms of being T2 or T3 stage on RRP pathology, positive or negative for PNI presence on PNB and positive or negative BR situation. Additionally the effect of PNI presence on recurrence-free survival (RFS) rate was investigated. When all patients are investigated, multivariate analysis observed that in T3 patients PSA, PNB Gleason score (GS) and tumor percentage were significantly higher; in PNI positive patients PNB GS, core number and tumor percentage were significantly higher and in BR positive patients PNB PNI positivity and core number were significantly higher compared to T2, PNI negative and BR negative patients, separately (p < 0.05). When D'Amico intermediate-risk patients are evaluated, for T3 patients PSA and PNB tumor percentage; for PNI positive patients PNB core number and tumor percentage; and for BR positive patients PNB PNI positivity were significantly higher compared to T2, PNI negative and BR negative patients, separately (p < 0.05). Mean RFS in the whole patient group was 56.4 ± 4.2 months for PNI positive and 96.1 ± 5.7 months for negative groups. In the intermediate-risk group, mean RFS was 53.7 ± 5.1 months for PNI positive and 100.3 ± 7.7 months for negative groups (p < 0.001). PNI positivity on PNB was shown to be an important predictive factor for increased T3 disease and BR rates and reduced RFS.
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Affiliation(s)
- Serdar Celik
- Department of Urology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Ozan Bozkurt
- Department of Urology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Omer Demir
- Department of Urology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ozgur Gurboga
- Department of Urology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Burcin Tuna
- Department of Pathology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Kutsal Yorukoglu
- Department of Pathology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Guven Aslan
- Department of Urology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
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