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Li J, Cohen RJ. Impact of Autonomic Nerve Invasion on Biochemical Recurrence for Intermediate Risk T3a Prostate Cancer With Negative Surgical Margins After Radical Prostatectomy. Urology 2024:S0090-4295(24)00643-5. [PMID: 39127159 DOI: 10.1016/j.urology.2024.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/23/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE To assess the impact of autonomic nerve invasion (ANI) on subsequent biochemical recurrence (BCR) or early adjuvant therapy in the patients with extraprostatic spread (EPS) and negative margins after radical prostatectomy (RP). METHODS A total of 218 men with EPS (T3a) and negative margins were identified who underwent RP in Western Australia from January 2014 to December 2016. The t-test, Pearson chi-square test and Kaplan-Meier method with the log-rank test were used to evaluate differences between the ANI and non-ANI. Univariate and multivariable Cox proportional hazard regression models were applied to assess the impact of these parameters on BCR or early treatment and a model calibration was performed by the internal validation method. RESULTS ANI group had a significantly higher incidence in BCR or early adjuvant therapy compared to non-ANI group (hazard ratio 1.94, 95% CI 1.12-3.37, P = .02). Further analyses showed that ANI was significantly associated with BCR or early adjuvant therapy (hazard ratio 3.03, 95% CI 1.28-7.15, P = .01) in intermediate-risk cases (Gleason sum (GS)= 7, ie, International Society of Urological Pathology (ISUP) groups 2/3) but not in high-risk group (GS≥8/ISUP 4/5). CONCLUSION For the patients with EPS (T3a) and negative margins, ANI significantly and independently increases the chances of BCR or early adjuvant therapy for intermediate-risk disease (GS=7/ISUP 2/3) but it is not an independent predictor for high-risk disease (GS≥8/ISUP 4/5). This provides a simple cost-effective method to further stratify margin negative intermediate-risk T3a prostate cancer.
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Affiliation(s)
- Jian Li
- Uropath Pty Ltd, Perth, Western Australia, Australia
| | - Ronald J Cohen
- Uropath Pty Ltd, Perth, Western Australia, Australia; Medical School, University of Western Australia, Perth, Western Australia, Australia.
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Perineural invasion as predictor of biochemical recurrence in prostate cancer following open radical prostatectomy: a single-center experience. World J Urol 2022; 40:2695-2700. [DOI: 10.1007/s00345-022-04158-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022] Open
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Madendere S, Türkkan G, Arda E, Yürüt Çaloğlu V, Kuyumcuoğlu U. Evaluation of Risk Groups for the Prediction of Biochemical Progression in Patients Undergoing Radical Prostatectomy. JOURNAL OF UROLOGICAL SURGERY 2022. [DOI: 10.4274/jus.galenos.2021.2021.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Wang F, Liu F, Liang J, Yang F, Xing N. Preoperative Platelet Count Correlates With Postoperative Perineural Invasion on Specimen in Patients Treated With Radical Prostatectomy. Front Oncol 2022; 12:906936. [PMID: 35747816 PMCID: PMC9209647 DOI: 10.3389/fonc.2022.906936] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/13/2022] [Indexed: 12/17/2022] Open
Abstract
Objective It has been reported that perineural invasion (PNI) after radical prostatectomy (RP) is associated with unfavorable prostate cancer (PCa) prognosis. However, the clinicopathological factors especially hematological parameters that influenced PNI remain unknown. Our aim was to explore the relationship between clinicopathological parameters and PNI in patients who underwent RP. Methods A total of 348 patients with PCa who underwent RP at our center between 2018 and 2021 were consecutively collected. We divided them into non-PNI and PNI groups based on PNI status and compared clinicopathological characteristics including hematological parameters between non-PNI and PNI groups. The association of clinicopathological parameters including whole blood parameters, age, body mass index (BMI), hypertension, diabetes mellitus, prostate-specific antigen (PSA), ISUP (International Society of Urological Pathology) grade, pathological stage T (pT), and neoadjuvant hormonal therapy (NHT) with PNI was determined by univariate and multivariate logistic regression analyses. Results The pathological results of the RP specimen consisted of 254 (73.0%) patients with PNI and 94 (27.0%) cases without PNI. The level of PSA, percentages of advanced pT and grade, positive surgical margin rate, and vessel carcinoma embolus rate were significantly higher in the PNI group when compared with non-PNI counterpart (p = 0.007, p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). Among the whole blood parameters, only platelet count and plateletcrit were significantly different [216 (178.8–252.0) vs. 200.5 (173.5–236.5), p = 0.04; 0.0021 (0.0018–0.0025) vs. 0.0020 (0.0017–0.0023), p = 0.008, respectively]. Univariate logistic regression analysis demonstrated that platelet, ISUP, and pT were all positively correlated with the presence of PNI (T3 vs. T1, odds ratio (OR) = 2.029, p = 0.020; OR = 1.697, p < 0.001; OR = 3.836, p < 0.001). In the stepwise multivariate regression analysis, the association between platelet and PNI remained significant (T2 vs. T1, OR = 2.171, 95% CI: 1.082–4.354, p = 0.029; T3 vs. T1, OR = 2.595, 95% CI: 1.259–5.349, p = 0.010) after adjusting for confounding factors including age, BMI, hypertension, diabetes mellitus, PSA, ISUP, pT, and NHT. Conclusions The study first revealed that platelet count rather than other whole blood parameters was independently associated with the presence of PNI in patients with PCa, suggesting that platelets might play an essential role in PCa aggressiveness.
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Affiliation(s)
- Fangming Wang
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Liu
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Liang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feiya Yang
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nianzeng Xing
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Urology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
- *Correspondence: Nianzeng Xing,
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Single Positive Core Prostate Cancer at Biopsy: Clinicopathological Implications and Risk Factors for Adverse Pathological Outcomes. Clin Genitourin Cancer 2021; 20:e205-e209. [PMID: 35027314 DOI: 10.1016/j.clgc.2021.12.013] [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: 09/22/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Whether one positive core prostate cancer (PCa) is a low-risk disease remains to be determined. We investigated the pathological results of radical prostatectomy specimens diagnosed on single core positive prostate biopsy. METHODS Between January 2013 and December 2019, A total of 3441 consecutive patients treated with radical prostatectomy in our institution were examined. Among them, 293 patients were diagnosed with single positive core PCa on biopsy, and the clinical parameters and pathological findings of their radical prostatectomy specimens were analyzed. RESULTS Of the 293 patients, 108 (36.9%) had undergraded Gleason Scores (GS) based on the biopsy. Positive surgical margins (PSMs), perineural invasion (PNI), extracapsular extension (ECE, pT3a) and seminal vesicle invasion (SVI, pT3b) were found in 16.4%, 15.0%, 3.4% and 2.4% of patients, respectively. In the multivariate analysis, we found that preoperative PSA level predict a significant increased risk of upgraded GS and PSMs, and biopsy GS was is a strong predictor of PNI, upgraded GS, tumor stage pT3 at radical prostatectomy. CONCLUSIONS Single positive core PCa have clinically significance in the radical prostatectomy specimens, with considerable rates of undergrading for the GS, PNI, PSMs, ECE and SVI. For patients with single positive core PCa, other prognostic factors must be considered in the treatment plan.
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Gun E, Ocal I. Cribriform glands are associated with worse outcome than other pattern 4 subtypes: A study of prognostic and clinicopathological characteristics of prostate adenocarcinoma with an emphasis on Grade Groups. Int J Clin Pract 2021; 75:e14722. [PMID: 34390077 DOI: 10.1111/ijcp.14722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022] Open
Abstract
AIM Although prostate adenocarcinoma is the most common cancer in men, survival is quite high and with the help of histopathological examination using the updated classification, patient management strategies are developing. We aimed to evaluate the correlation between the histopathological features and biochemical recurrence (BCR) in patients who underwent radical prostatectomy (RP) using the new classification. METHODS A total of 285 prostate adenocarcinoma cases that underwent RP between January 2009 and December 2017 and followed up for at least 3 months were included in the study. The cases were re-evaluated according to WHO-ISUP 2016 classification and the findings were recorded. RESULTS The mean age was 63,4 years. Gleason scores of the cases were as follows: 3+3 144 cases (50.5%), 3+4 81 cases (28.4%), 4+3 28 cases (9.8%), 4+4 7 cases (2.5%) , 3+5 6 cases (2.1%), 5+3 2 cases (0.7%), 4+5 17 cases (6%). There were 198 (69,5%) pT2, 54 (18,9%) pT3a and 33 (11,6%) pT3b cases. The mean follow-up time was 44,1 months and BCR was detected in 97 cases (34%). The relationship between the Group Grades and BCR was statistically significant. BCR rate increased as the tumour volume and the percentage of pattern 4 increased (P < .001).There was a significant correlation between preoperative PSA value, extraprostatic extension, seminal vesicle invasion, surgical margin positivity, tumour volume, pattern 4 percentage, presence of cribriform glands and BCR and recurrence-free survival in both univariate and multivariate analysis and recurrence-free survival was also affected by these parameters. Among the morphological subtypes of Pattern 4, recurrence-free survival decreased as the incidence of cribriform glands increased (P < .001). CONCLUSION Histopathological evaluation is important in predicting BCR in prostate adenocarcinoma, the Group Grade system seems to be helpful in this regard. More studies are needed to prove the relatively worse prognostic effect of cribriform glands.
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Affiliation(s)
- Eylul Gun
- Department of Pathology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Irfan Ocal
- Department of Pathology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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Sigorski D, Gulczyński J, Sejda A, Rogowski W, Iżycka-Świeszewska E. Investigation of Neural Microenvironment in Prostate Cancer in Context of Neural Density, Perineural Invasion, and Neuroendocrine Profile of Tumors. Front Oncol 2021; 11:710899. [PMID: 34277455 PMCID: PMC8281889 DOI: 10.3389/fonc.2021.710899] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
Background Cancer stroma contains the neural compartment with specific components and action. Neural microenvironment processing includes among others axonogenesis, perineural invasion (PNI), neurosignaling, and tumor cell neural/neuroendocrine differentiation. Growing data suggest that tumor-neural crosstalk plays an important function in prostate cancer (PCa) biology. However, the mechanisms involved in PNI and axonogenesis, as well as their patho-clinical correlations in this tumor are unclear. Methods The present study was carried out on FFPE samples of 73 PCa and 15 benign prostate (BP) cases. Immunohistochemistry with neural markers PGP9.5, TH, and NFP was performed on constructed TMAs and selected tissue sections. The analyzed parameters of tumor innervation included small nerve density (ND) measured on pan-neural marker (PGP9.5) and TH s4tained slides, as well assessment of PNI presence and morphology. The qualitative and topographic aspects were studied. In addition, the expression of neuroendocrine marker chromogranin and NPY was assessed with dedicated indexes. The correlations of the above parameters with basic patho-clinical data such as patients’ age, tumor stage, grade, angioinvasion, and ERG status were examined. Results The study showed that innervation parameters differed between cancer and BP. The neural network in PCa revealed heterogeneity, and ND PGP9.5 in tumor was significantly lower than in its periphery. The density of sympathetic TH-positive fibers and its proportion to all fibers was lower in cancer than in the periphery and BP samples. Perineural invasion was confirmed in 76% of cases, usually multifocally, occurring more commonly in tumors with a higher grade. NPY expression in PCa cells was common with its intensity often rising towards PNI. ERG+ tumors showed higher ND, more frequent PNI, and a higher stage. Moreover, chromogranin-positive cells were more pronounced in PCa with higher NPY expression. Conclusions The analysis showed an irregular axonal network in prostate cancer with higher neural density (panneural and adrenergic) in the surroundings and the invasive front. ND and PNI interrelated with NPY expression, neuroendocrine differentiation, and ERG status. The above findings support new evidence for the presence of autocrine and paracrine interactions in prostate cancer neural microenvironment.
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Affiliation(s)
- Dawid Sigorski
- Department of Oncology, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.,Department of Oncology and Immuno-Oncology, Warmian-Masurian Cancer Center of the Ministry of the Interior and Administration Hospital, Olsztyn, Poland
| | - Jacek Gulczyński
- Department of Pathology and Neuropathology, Medical University of Gdańsk, Gdańsk, Poland.,Department of Pathomorphology, Copernicus Hospital, Gdańsk, Poland
| | - Aleksandra Sejda
- Department of Pathomorphology, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Wojciech Rogowski
- Department of Health, Pomeranian University in Słupsk, Słupsk, Poland.,Department of Oncology, Chemotherapy, Clinical trials, Regional Hospital, Słupsk, Poland
| | - Ewa Iżycka-Świeszewska
- Department of Pathology and Neuropathology, Medical University of Gdańsk, Gdańsk, Poland.,Department of Pathomorphology, Copernicus Hospital, Gdańsk, Poland
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Ramos N, Macedo A, Rosa J, Carvalho M. Perineural invasion in prostate needle biopsy: Prognostic value on radical prostatectomy and active surveillance. ACTA ACUST UNITED AC 2020; 92. [PMID: 33348961 DOI: 10.4081/aiua.2020.4.330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/03/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE The aim of this study was to evaluate the clinical impact of perineural invasion (PNI) in prostate biopsy in patients submitted to radical prostatectomy and on active surveillance (AS). MATERIALS AND METHODS We performed a single center, retrospective, cohort study on patients diagnosed with clinically localized prostate cancer and submitted to radical prostatectomy between January 2010 and December 2016. We evaluated clinical and anatomopathological characteristics from the biopsy and radical prostatectomy specimen and correlated with biochemical recurrence (BCR) using a survival analysis. We also evaluated the impact of PNI in patients with criteria for active surveillance. RESULTS The cohort analyzed consists of 107 patients, with a mean age of 63.1 years and a mean PSA prior to biopsy of 7.8 ng/ml. In prostate biopsy, 66.4% of the patients had a Gleason score of 6, 30.9% had a Gleason score of 7, and 2.7% had a Gleason score of 8 or higher, with PNI being detected in 57 (53.3%) of the patients. Regarding the anatomopathological characteristics of the surgical specimen, invasion of the seminal vesicles was observed in 6.5%, lymph nodes involvement in 9.3% and positive surgical margins in 27.1% of the cases. During follow-up, BCR was recorded in 24.3% of cases. Clinicopathological features were stratified according to the presence or absence of PNI, with statistical significance in relation to the Gleason Score (p = 0.001), pathologic T stage (p = 0.001), D'Amico risk (p = 0.002) and upstaging of the Gleason score (p = 0.045). The survival analysis revealed a relationship between PNI and BCR (hazard ratio = 2.98; 95% CI: 1.36-6.58; p = 0.007). Regarding the men potentially eligible for AS, the presence of PNI on the biopsy presented a significant relation with Gleason upgrade (p = 0.004) and extraprostatic extension (p = 0.017). CONCLUSIONS The presence of PNI in prostate biopsy is related to adverse anatomopathological factors, being a potential predictor of BCR and have a possible role in the selection of patients for AS.
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Affiliation(s)
- Nuno Ramos
- Urology Department, Garcia de Orta Hospital, Almada.
| | | | - João Rosa
- Urology Department, Garcia de Orta Hospital, Almada.
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Wu S, Xie L, Lin SX, Wirth GJ, Lu M, Zhang Y, Blute ML, Dahl DM, Wu CL. Quantification of perineural invasion focus after radical prostatectomy could improve predictive power of recurrence. Hum Pathol 2020; 104:96-104. [PMID: 32673683 DOI: 10.1016/j.humpath.2020.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 01/04/2023]
Abstract
Perineural invasion (PNI) after radical prostatectomy (RP) is a common feature of prostate cancer (PCa) and has been associated with unfavorable tumor characteristics. However, its prognostic relevance is controversial. In this study, we evaluated the impact of both PNI status (PNI+ versus PNI-) and quantified number of PNI focus on the long-term prognosis of biochemical recurrence (BCR) after RP. After reevaluating PNI of a total of 721 patients with localized PCa who underwent RP at our institution between 2000 and 2002, we examined associations between PNI status or PNI focus number and clinicopathological factors including tumor stage, Gleason score, margin status, tumor location, preoperative prostate specific antigen, age, prostate weight as well as BCR outcome. PNI was present in 530 of 721 cases (73.5%) of the RP specimens and was associated with more aggressive disease. BCR occurred in 19.4% of all patients within a median follow-up period of 8.5 years. PNI+ status was associated with poor BCR prognosis in univariate analysis but lost in multivariate analysis. Based on the number of PNI focus, PNI was further divided into 2 distinct group: PNI+ a (≤3) and PNI+ b (>3). In a multivariate Cox regression model, PNI+ b (>3) was identified as an independent BCR prognostic factor. Quantification of PNI focus number beside the dichotomized status recording will not only provide more detailed information but also be a novel prognostic indicator for risk stratification. Further external validation will be needed for an optimal cut-off value of the PNI focus number. Our findings will help further research on the relevance of PNI in the pretreatment setting and support ongoing efforts to understand its role of cancer progression.
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Affiliation(s)
- Shulin Wu
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Ling Xie
- Department of Pathology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Sharron X Lin
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Gregory J Wirth
- Division of Urology, Department of Surgery, Geneva University Hospital, Geneva, 1205, Switzerland
| | - Min Lu
- Department of Pathology, Peking University Third Hospital, Peking University Health Science Center, Beijing, 100191, China
| | - Yifen Zhang
- Department of Pathology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Michael L Blute
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Douglas M Dahl
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
| | - Chin-Lee Wu
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
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10
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Erdem S, Verep S, Bagbudar S, Ozluk Y, Sanli O, Ozcan F. The clinical predictive factors and postoperative histopathological parameters associated with upgrading after radical prostatectomy: A contemporary analysis with grade groups. Prostate 2020; 80:225-234. [PMID: 31794085 DOI: 10.1002/pros.23936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIM Upgrading after radical prostatectomy (RP) is an ongoing problem since first description of Gleason score. In this retrospective study, our aim is to investigate upgrading after RP in grade groups (GG) and clinical predictive, and postoperative histopathological factors associated with GG upgrading (GGU). PATIENTS AND METHODS A total of 753 patients undergoing RP between January 2006 and June 2019 at our institution were investigated. Overall cohort were divided into two groups according to GGU status after RP as nonupgrading and upgrading. Retrospectively documented preoperative clinical and postoperative histopathological parameters were compared between two groups. Furthermore, we investigated a subgroup of institutional cohort (n = 398) whose prostate biopsy (Pbx) and RP were performed in our institution and we also divided this cohort into two groups according to GGU status. χ2 and Mann-Whitney U tests were used for comparative analyses. The independent preoperative predictive and postoperative histopathological factors associated with GGU were investigated using multivariate logistic regression analysis. RESULTS The total GGU was 55.8% in overall cohort and 45.2% in institutional cohort. The GGU was found as the most common in bioptic GG1 group in both overall (64.0%), and institutional (54.5%) cohorts. In multivariate analyses, the noninstitutional Pbx (odds ratio [OR] = 2.56; 95% confidence interval [CI]: 1.86-3.51; P < .001), tumor positive core numbers in Pbx (OR = 1.11; 95%CI: 1.04-1.19; P = .003), increased prostate specific antigen (PSA) density (OR = 3.59; 95%CI: 1.03-12.52, P = .045) and age (OR = 1.03; 95%CI: 1.00-1.05, P = .046) were independent clinical predictors of GGU in overall cohort whereas only increased PSA density (OR = 5.94; 95%CI: 1.28-27.50; P = .023) was independent predictor in institutional cohort. Among postoperative histopathological factors, perineural invasion (OR = 1.57; 95%CI: 1.70-3.87; P < .001 and OR = 2.53; 95%CI: 1.46-4.40; P = .001, respectively), increased maximum tumor diameter (OR = 1.46; 95%CI: 1.23-1.73; P < .001 and OR = 1.33; 95%CI: 1.07-1.66; P = .010, respectively), and high-grade prostatic intraepithelial neoplasia (HGPIN) existence at tumor surrounding tissue (OR = 1.96; 95%CI: 1.32-2.90; P = .001 and OR = 1.87; 95%CI: 1.10-3.21; P = .022, respectively) were independently associated with GGU after RP, in both of overall and institutional cohorts. CONCLUSIONS Noninstitutional prostate biopsy, increased PSA density, higher tumor positive cores in Pbx and older age are the clinical predictors of upgrading after RP in contemporary GG. Perineural invasion, increased maximum tumor diameter, and HGPIN existence at tumor surrounding tissue are postoperative histopathological factors associated with GGU.
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Affiliation(s)
- Selcuk Erdem
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Samed Verep
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sidar Bagbudar
- Department of Pathology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Oner Sanli
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Faruk Ozcan
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
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Reeves FA, Battye S, Roth H, Peters JS, Hovens C, Costello AJ, Corcoran NM. Prostatic nerve subtypes independently predict biochemical recurrence in prostate cancer. J Clin Neurosci 2019; 63:213-219. [PMID: 30772200 DOI: 10.1016/j.jocn.2019.01.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 01/31/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To describe nerve subtypes involved by perineural invasion (PNI) in prostate cancer and their relationship with clinicopathological parameters and recurrence risk. METHODS 141 prostatectomy specimens from men with localized prostate cancer and known perineural invasion were analyzed. Index tumor blocks were stained for perineural invasion and sympathetic/parasympathetic markers. For 98 patients with complete staining, nerves from up to three hotspot regions of intraprostatic perineural invasion were classified according to autonomic subtype and perineural invasion status. Findings were correlated with prospectively collected clinicopathological data. Biochemical recurrence predictors were tested in univariable and multivariable models. RESULTS Most intra-prostatic nerves contained sympathetic and parasympathetic fibres, irrespective of perineural invasion status. A fraction was purely sympathetic (5% PNI, 2% non-PNI) or double-negative (non-adrenergic, non-nitrergic; 1% PNI, 1% non-PNI). Perineural invasion nerve count was associated with higher pathological stage. Although total perineural invasion or non-perineural invasion nerve count did not predict biochemical recurrence, two subtypes were found to be independent predictors: pure sympathetic non-perineural invasion nerves (HR 6.79, p = 0.03) and non-adrenergic, non-nitrergic PNI nerves (HR 10.56, p < 0.005). CONCLUSIONS Pure sympathetic nerve density without tumour invasion and perineural invasion specifically involving non-adrenergic, non-nitrergic fibres are independent predictors of biochemical recurrence post prostatectomy, supporting a role for the autonomic nervous system in prostate cancer progression.
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Affiliation(s)
- Fairleigh A Reeves
- Department of Surgery, Division of Urology, University of Melbourne, Royal Melbourne Hospital, Australia; Urology Unit, Department of Surgery, Peninsula Health, Australia.
| | | | - Hedley Roth
- Urology Unit, Department of Surgery, Peninsula Health, Australia
| | - Justin S Peters
- Department of Surgery, Division of Urology, University of Melbourne, Royal Melbourne Hospital, Australia; Australian Prostate Cancer Research Centre Epworth, Richmond, Australia
| | - Christopher Hovens
- Department of Surgery, Division of Urology, University of Melbourne, Royal Melbourne Hospital, Australia; Australian Prostate Cancer Research Centre Epworth, Richmond, Australia
| | - Anthony J Costello
- Department of Surgery, Division of Urology, University of Melbourne, Royal Melbourne Hospital, Australia; Australian Prostate Cancer Research Centre Epworth, Richmond, Australia
| | - Niall M Corcoran
- Department of Surgery, Division of Urology, University of Melbourne, Royal Melbourne Hospital, Australia; Urology Unit, Department of Surgery, Peninsula Health, Australia; Australian Prostate Cancer Research Centre Epworth, Richmond, Australia
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Kraus RD, Barsky A, Ji L, Garcia Santos PM, Cheng N, Groshen S, Vapiwala N, Ballas LK. The Perineural Invasion Paradox: Is Perineural Invasion an Independent Prognostic Indicator of Biochemical Recurrence Risk in Patients With pT2N0R0 Prostate Cancer? A Multi-Institutional Study. Adv Radiat Oncol 2018; 4:96-102. [PMID: 30706016 PMCID: PMC6349660 DOI: 10.1016/j.adro.2018.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/24/2018] [Accepted: 09/10/2018] [Indexed: 11/27/2022] Open
Abstract
Purpose Perineural invasion (PNI) is a histologic feature that is present in as many as 84% of patients with prostate cancer. The prognostic significance of PNI is controversial, with recent studies yielding contradictory results. This study aims to assess whether PNI, on the surgical pathology of patients with pT2N0M0 disease and with negative surgical margins, is an independent prognostic indicator of the risk of biochemical recurrence. Methods and materials We identified 1549 patients who received a diagnosis of margin-negative pT2N0M0 prostate cancer at 3 separate institutions between January 1, 2008 and December 31, 2014. We reviewed the electronic medical records of these patients and collected clinical and histologic data. A multivariable analysis was performed to assess the association between PNI and biochemical recurrence. Results Of the 1549 patients identified, 936 (60.4%) had PNI and 96 (6.2%) had biochemical recurrence. The median time until recurrence was 16 months. The median follow-up in patients without recurrence was 26.5 months. PNI was associated with pT2c disease. The proportion of patients with pT2c was 89% in patients with PNI compared with 79% in patients without PNI (P < .001). PNI was also associated with a higher surgical Gleason score (of those with vs without PNI, 21% vs 50% had Gleason score 3 + 3; 62% vs 41% had a Gleason score 3 + 4, 12% vs 5% had a Gleason score 4 + 3; and 5% vs 3% had a Gleason score 8-10; P < .001). On univariate analysis, patients with PNI appeared to be more likely to have disease recurrence (hazard ratio: 1.7; 95% confidence interval, 1.1-2.6; P = .015). However, after adjusting for other variables, there was not a significant association between PNI and recurrence (hazard ratio: 1.1; 95% confidence interval, 0.70-1.8: P = .65). Conclusions We found that PNI was not an independent indicator of the risk of biochemical recurrence. Instead, PNI may be an indicator of unfavorable histology such as a high Gleason score or diffuse disease within the prostate in pT2N0 patients.
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Affiliation(s)
- Ryan Douglas Kraus
- University of Southern California, Keck School of Medicine, Department of Radiation Oncology, Los Angeles, California
| | - Andrew Barsky
- Perelman School of Medicine, Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lingyun Ji
- University of Southern California, Keck School of Medicine, Department of Preventative Medicine, Los Angeles, California
| | - Patricia Mae Garcia Santos
- Perelman School of Medicine, Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nathan Cheng
- University of Southern California, Keck School of Medicine, Department of Urology, Los Angeles, California
| | - Susan Groshen
- University of Southern California, Keck School of Medicine, Department of Preventative Medicine, Los Angeles, California
| | - Neha Vapiwala
- Perelman School of Medicine, Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Leslie K Ballas
- University of Southern California, Keck School of Medicine, Department of Radiation Oncology, Los Angeles, California
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13
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Zhang L, Wu B, Zha Z, Zhao H, Jiang Y, Yuan J. Positive surgical margin is associated with biochemical recurrence risk following radical prostatectomy: a meta-analysis from high-quality retrospective cohort studies. World J Surg Oncol 2018; 16:124. [PMID: 29970100 PMCID: PMC6029044 DOI: 10.1186/s12957-018-1433-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/26/2018] [Indexed: 01/06/2023] Open
Abstract
Background and purpose Although numerous studies have shown that positive surgical margin (PSM) is linked to biochemical recurrence (BCR) in prostate cancer (PCa), the research results have been inconsistent. This study aimed to explore the association between PSM and BCR in patients with PCa following radical prostatectomy (RP). Materials and methods In accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), PubMed, EMBASE and Wan Fang databases were searched for eligible studies from inception to November 2017. The Newcastle–Ottawa Scale was used to assess the risk of bias of the included studies. Meta-analysis was performed by using Stata 12.0. Combined hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were calculated using random-effects or fixed-effects models. Results Ultimately, 41 retrospective cohort studies of high quality that met the eligibility criteria, comprising 37,928 patients (94–3294 per study), were included in this meta-analysis. The results showed that PSM was associated with higher BCR risk in both univariate analysis (pooled HR = 1.56; 95% CI 1.46, 1.66; p < 0.001) and multivariate analysis (pooled HR = 1.35; 95% CI 1.27, 1.43; p < 0.001). Moreover, no potential publication bias was observed among the included studies in univariate analysis (p-Begg = 0.971) and multivariate analysis (p-Begg = 0.401). Conclusions Our meta-analysis demonstrated that PSM is associated with a higher risk of BCR in PCa following RP and could serve as an independent prognostic factor in patients with PCa. Electronic supplementary material The online version of this article (10.1186/s12957-018-1433-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lijin 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
| | - Zhenlei Zha
- Departments of Urology, 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
| | - Yuefang Jiang
- 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
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14
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Ram D, Rajappa SK, Rawal S, Singh A, Sharma KC, Dewan AK. Clinical Significance of Incidental Prostatic Carcinoma on Radical Cystectomy Histology Specimens: a Clinicopathological and Survival Analysis. Indian J Surg Oncol 2018; 9:192-198. [PMID: 29887700 DOI: 10.1007/s13193-018-0756-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 04/10/2018] [Indexed: 11/29/2022] Open
Abstract
Incidental prostatic carcinoma on radical cystectomy histology specimens is not an uncommon entity and managing such cases is still controversial. Classification into clinically significant and insignificant cancers by Epstein based on the assumption that one is more likely to affect the survival than the other is not universally accepted. We conducted this retrospective analysis with the aim to find out the role of dichotomization of incidental prostatic cancer into such classification. Patient's data were retrospectively reviewed from January 2013 to December 2014. A total of 175 patients underwent radical cystectomy during the study duration and amongst them, 38 specimens showed incidental prostatic cancer. Their data pertaining to demographic profile, clinicopathological details, treatment received, complications and follow-up data was recorded. On comparative analysis, the disease-free survival in csPCa (clinically significant prostatic cancer) group was 60.82% and cisPCa (clinically insignificant prostatic cancer) 62.68% at 2.3 years (p 0.566), while OS was 55.68% for csPCa and 87.5% for cisPCa respectively (p 0.814). The mean duration to recurrence was also comparable (19.4 months csPCa and 17 months cisPCa). None of the patients developed PSA elevation on follow-up and none of the recurrence or death were attributed to prostatic cancer. The stage of bladder cancer was the only factor, which had a significant impact on overall survival. The distinction between clinically significant and insignificant is not relevant according to our analysis.
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Affiliation(s)
- Dharma Ram
- 1Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, 110085 India
| | - Suhas K Rajappa
- 1Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, 110085 India
| | - Sudhir Rawal
- 2Department of Uro-Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, 110085 India
| | - Amitabh Singh
- 2Department of Uro-Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, 110085 India
| | - Kailash Chand Sharma
- 1Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, 110085 India
| | - Ajay Kumar Dewan
- 1Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, 110085 India
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15
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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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16
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Lubig S, Thiesler T, Müller S, Vorreuther R, Leipner N, Kristiansen G. Quantitative perineural invasion is a prognostic marker in prostate cancer. Pathology 2018; 50:298-304. [PMID: 29448999 DOI: 10.1016/j.pathol.2017.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 08/22/2017] [Accepted: 08/31/2017] [Indexed: 01/16/2023]
Abstract
This study aimed to investigate the prognostic value of a quantitative, detailed, yet practical analysis of perineural invasion in radical prostatectomy specimens in a high-risk prostate cancer cohort. A total of 114 patients with prostate cancer who underwent radical prostatectomy between 2000 and 2013 were analysed. Using S100 protein immunohistochemistry assisted in the detection of nerves. In the area of closest proximity of the tumour to the dorso-lateral margins, nerves were counted and the infiltration of nerves was categorised (0-3). Category 0 was nerves without immediate tumour-cell-contact. All nerves being fully surrounded by tumour (classical perineural carcinosis) were categorised group 3. Two further categories discriminated between nerves that were touched either by carcinoma cells below 50% of the circumference (category 1) or above (category 2). Perineural carcinosis (Pn1) was seen in 61.4% of cases and correlated positively with ISUP grades, pT categories and presence of intraductal carcinoma but failed significance on Kaplan-Meier analysis. A more quantitative analysis of percentual perineural involvement did demonstrate significant survival differences: cases with less than one Pn1-positive nerve in 5 high power fields had longer survival times. Incomplete perineural involvement (category 1-2) did not have a prognostic value, endorsing the current definition of perineural carcinosis as full circumferential encasement of a nerve by tumour cells. A quantitative analysis of the percentage of nerves positive for perineural invasion has a higher prognostic value than the classical dichotomous statement on the mere presence of perineural invasion.
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Affiliation(s)
- Sabine Lubig
- Institute of Pathology of the University Hospital Bonn, Bonn, Germany
| | - Thore Thiesler
- Institute of Pathology of the University Hospital Bonn, Bonn, Germany
| | - Stefan Müller
- Department of Urology of the University Hospital Bonn, Bonn, Germany
| | | | | | - Glen Kristiansen
- Institute of Pathology of the University Hospital Bonn, Bonn, Germany.
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17
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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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18
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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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19
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Sun G, Huang R, Zhang X, Shen P, Gong J, Zhao J, Liu J, Tang Q, Shu K, Yin X, Chen N, Zeng H. The impact of multifocal perineural invasion on biochemical recurrence and timing of adjuvant androgen-deprivation therapy in high-risk prostate cancer following radical prostatectomy. Prostate 2017; 77:1279-1287. [PMID: 28752514 DOI: 10.1002/pros.23388] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 06/22/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Perineural invasion (PNI) is a distinct pathologic entity and a recognized source of tumor spread. However, the role of PNI in high-risk prostate cancer (PCa) has not been explored. The aims of the study were to investigate the impact of PNI on biochemical recurrence (BCR) and optimal timing of adjuvant androgen-deprivation therapy (ADT) after radical prostatectomy (RP). METHODS A total of 265 prostatectomies, median follow-up 45 months, were assessed for the presence and intensity of PNI (unifocal and multifocal) in RP specimens. Kaplan-Meier curves were used to estimate BCR probabilities. Cox proportional hazard models were used to address predictors of BCR. Harrell's C-index was conducted to further validate prognostic value of multi-PNI. RESULTS A total of 123 patients (46.4%) were PNI positive, among which, 91 (74%) and 32 (26%) had unifocal PNI (uni-PNI) and multifocal PNI (multi-PNI), respectively. The presence of multi-PNI was strongly associated with increasing incidence of BCR (HR = 3.87, 95%CI: 1.66-9.01, P = 0.002). Patients with uni-PNI had a similar BCR rate to those without PNI after adjuvant ADT. For men with multi-PNI, immediate ADT was superior to delayed ADT in decreasing biochemical failure. CONCLUSIONS Our findings suggest that detection of multi-PNI in high-risk RP specimens could be a prognosticator for early biochemical relapse post-surgery. Initiation of adjuvant therapy may be appropriate in patients with multi-PNI as soon as possible after surgery.
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Affiliation(s)
- Guangxi Sun
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Huang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xingming Zhang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Pengfei Shen
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Gong
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinge Zhao
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiandong Liu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qidun Tang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Kunpeng Shu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoxue Yin
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Ni Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Zeng
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
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20
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Zareba P, Flavin R, Isikbay M, Rider JR, Gerke TA, Finn S, Pettersson A, Giunchi F, Unger RH, Tinianow AM, Andersson SO, Andrén O, Fall K, Fiorentino M, Mucci LA. Perineural Invasion and Risk of Lethal Prostate Cancer. Cancer Epidemiol Biomarkers Prev 2017; 26:719-726. [PMID: 28062398 DOI: 10.1158/1055-9965.epi-16-0237] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 12/07/2016] [Accepted: 12/08/2016] [Indexed: 12/12/2022] Open
Abstract
Background: Prostate cancer has a propensity to invade and grow along nerves, a phenomenon called perineural invasion (PNI). Recent studies suggest that the presence of PNI in prostate cancer has been associated with cancer aggressiveness.Methods: We investigated the association between PNI and lethal prostate cancer in untreated and treated prostate cancer cohorts: the Swedish Watchful Waiting Cohort of 615 men who underwent watchful waiting, and the U.S. Health Professionals Follow-Up Study of 849 men treated with radical prostatectomy. One pathologist performed a standardized histopathologic review assessing PNI and Gleason grade. Patients were followed from diagnosis until metastasis or death.Results: The prevalence of PNI was 7% and 44% in the untreated and treated cohorts, respectively. PNI was more common in high Gleason grade tumors in both cohorts. PNI was associated with enhanced tumor angiogenesis, but not tumor proliferation or apoptosis. In the Swedish study, PNI was associated with lethal prostate cancer [OR 7.4; 95% confidence interval (CI), 3.6-16.6; P < 0.001]. A positive, although not statistically significant, association persisted after adjustment for age, Gleason grade, and tumor volume (OR 1.9; 95% CI, 0.8-5.1; P = 0.17). In the U.S. study, PNI predicted lethal prostate cancer independent of clinical factors (HR 1.8; 95% CI, 1.0, 3.3; P =0.04).Conclusions: These data support the hypothesis that perineural invasion creates a microenvironment that promotes cancer aggressiveness.Impact: Our findings suggest that PNI should be a standardized component of histopathologic review, and highlights a mechanism underlying prostate cancer metastasis. Cancer Epidemiol Biomarkers Prev; 26(5); 719-26. ©2017 AACR.
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Affiliation(s)
- Piotr Zareba
- Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Richard Flavin
- Department of Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Trinity College Dublin, Dublin, Ireland
| | | | - Jennifer R Rider
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Travis A Gerke
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | - Stephen Finn
- Department of Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Trinity College Dublin, Dublin, Ireland
| | - Andreas Pettersson
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Clinical Epidemiology Unit, Department of Medicine, Solna, Stockholm, Sweden
| | - Francesca Giunchi
- Pathology Unit, Addarii Institute, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Robert H Unger
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Alex M Tinianow
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Swen-Olof Andersson
- Department of Urology, Örebro University Hospital, Örebro, Sweden.,School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Ove Andrén
- Department of Urology, Örebro University Hospital, Örebro, Sweden.,School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Katja Fall
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Michelangelo Fiorentino
- Department of Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.,Pathology Unit, Addarii Institute, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Lorelei A Mucci
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts. .,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Public Health Sciences, University of Iceland, Reykjavik, Iceland
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21
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Kang M, Oh JJ, Lee S, Hong SK, Lee SE, Byun SS. Perineural Invasion and Lymphovascular Invasion are Associated with Increased Risk of Biochemical Recurrence in Patients Undergoing Radical Prostatectomy. Ann Surg Oncol 2016; 23:2699-706. [PMID: 26965702 DOI: 10.1245/s10434-016-5153-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE This study was designed to determine whether perineural invasion (PNI) and lymphovascular invasion (LVI) are independent predictors for biochemical recurrence (BCR) of prostate cancer (PCa) following radical prostatectomy (RP) in the Asian population. METHODS The study population comprised 2394 PCa patients undergoing RP at our institution in Korea. After excluding 360 patients, we compared the baseline characteristics between the groups according to the presence of PNI or LVI and estimated BCR-free survival using the Kaplan-Meier survival. Multivariate Cox regression model was adopted to identify significant predictive factors of BCR following RP. RESULTS Among 2034 patients, PNI and LVI were detected in 69.3 and 12.4 % patients, respectively. Patients with PNI or LVI had higher rates of advanced biopsy and pathological Gleason score (≥7), and higher proportions of advanced clinical and pathological T stage ≥3, extraprostatic extension, seminal vesicle invasion, and surgical margin positivity. Notably, BCR-free survival was lower in patients with PNI or LVI compared with that in patients without these markers and lower in patients with both markers compared with that in other populations of patients. Moreover, PNI (hazard ratio [HR] = 2.11) and LVI (HR = 1.57) were significant predictors of BCR. The presence of the two markers was associated with a higher risk of BCR (HR = 4.60) compared with the presence of either marker alone (HR = 3.47). CONCLUSIONS PNI and LVI are adverse pathologic parameters and independent predictors for BCR, and the concurrent presence of PNI and LVI resulted in poorer outcomes for BCR in PCa patients who underwent RP.
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Affiliation(s)
- Minyong Kang
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jong Jin Oh
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea.
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22
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Turk H, Celik O, Un S, Yoldas M, İsoglu CS, Karabicak M, Ergani B, Koc G, Zorlu F, Ilbey YO. Predictive factors for biochemical recurrence in radical prostatectomy patients. Cent European J Urol 2016; 68:404-9. [PMID: 26855791 PMCID: PMC4742437 DOI: 10.5173/ceju.2015.606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/25/2015] [Accepted: 08/28/2015] [Indexed: 11/29/2022] Open
Abstract
Introduction Radical prostatectomy (RP) is considered the best treatment for the management of localized prostate cancer in patients with life expectancy over 10 years. However, a complete recovery is not guaranteed for all patients who received/underwent RP treatment. Biochemical recurrence is frequently observed during the post-operative follow-up period. The main objective in this study is to evaluate the predictive factors of biochemical recurrence in localized prostate cancer patients who underwent RP surgery Material and methods The study included 352 patients with prostate cancer treated by RP at a single institution between February 2004 and June 2014. Detailed pathological and follow-up data of all patients were obtained and analyzed to determine the results. Results Mean follow-up duration was 39.7 months. 83 patients (23%) experienced biochemical recurrence (BCR) during the follow-up period. Mean BCR duration range was 6.56 (1–41) months. In multivariate logistic regression analysis, Gleason score (GS), PSA and extra-capsular tumour spread (ECS) variables were found to be statistically significant as BCR predictive factors. Conclusions According to our study results, it is thought that PSA, GS and ECS can all be used for guidance in choosing a treatment modality for post-RP biochemical recurrence and metastatic disease as predictive factors. However, there is no consensus in this matter and it is still debated.
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Affiliation(s)
- Hakan Turk
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| | - Orcun Celik
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| | - Sitki Un
- Katip Celebi University Medical School Hospital, Izmir, Turkey
| | - Mehmet Yoldas
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| | - Cemal Selcuk İsoglu
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| | - Mustafa Karabicak
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| | - Batuhan Ergani
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| | - Gokhan Koc
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| | - Ferruh Zorlu
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| | - Yusuf Ozlem Ilbey
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
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