The prognostic significance of perineural invasion and race in men considering active surveillance. (22nd January 2014)

• Record Type: Journal Article
• Authors: Cohn, Joshua A.; Dangle, Pankaj P.; Wang, Chihsiung E.; Brendler, Charles B.; Novakovic, Kristian R.; McGuire, Michael S.; Helfand, Brian T.
• Is Part Of: BJU international. Volume 114:Number 1(2014:Jul.)
• Page Start: 75
• Page End: 80
• Publication Date: 2014-01-22
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12463
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12463-sec-0001" sec-type="section"> <title>Objective</title> <p> <list id="bju12463-list-0001" list-type="bullet"> <list-item> <p>To determine the importance of perineural invasion (PNI) on diagnostic biopsy in men enrolled in active surveillance (AS).</p> </list-item> </list> </p> </sec> <sec id="bju12463-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju12463-list-0002" list-type="bullet"> <list-item> <p>Eligibility criteria for AS included clinical stage ≤ T2a and Gleason score ≤6, ≤3 cores positive, maximum single core involvement <50%, and total tumour volume ≤5% on diagnostic biopsy.</p> </list-item> <list-item> <p>All men received 12‐core confirmation biopsy at ≤6 months.</p> </list-item> <list-item> <p>AS 'failure' on confirmatory biopsy was defined as failure to meet one or more eligibility criteria.</p> </list-item> <list-item> <p>Risk of AS failure was compared in men with and without PNI.</p> </list-item> </list> </p> </sec> <sec id="bju12463-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju12463-list-0003" list-type="bullet"> <list-item> <p>For the 165 men comprising the study population, the mean (<sc>sd</sc>) age was 66.9 (6.5) years and the median (interquartile, IQR) PSA level of men at study entry was 4.4 (3.2–6.0) ng/mL. The median (IQR) follow‐up was 5.5 (1.1–9.9) months.</p> </list-item> <list-item> <p>In all, 8.5% (14/165 men) had PNI on diagnostic biopsy.</p> </list-item> <list-item> <p>Compared with those without PNI, men with PNI tended to have more cores involved with cancer, at a mean (<sc>sd</sc>) of 2.0 (0.7) vs 1.6 (0.8) cores (<italic>P</italic> = 0.08) but did not have significantly a greater mean (<sc>sd</sc>) total tumour length on diagnostic biopsy, at 3.0 (2.1) vs 2.3 (3.6) mm (<italic>P</italic> = 0.27).</p> </list-item> <list-item> <p>Men with PNI on diagnostic biopsy were significantly more likely to meet criteria for disease progression on confirmatory biopsy (57% [8/14] vs 21% [32/151]; <italic>P</italic> = 0.006).</p> </list-item> <list-item> <p>PNI remained a significant predictor for AS failure after adjustment for number of positive cores, maximum percentage core involvement, and total tumour length (odds ratio 4.4, 95% confidence interval 1.4–14.2).</p> </list-item> </list> </p> </sec> <sec id="bju12463-sec-0004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju12463-list-0004" list-type="bullet"> <list-item> <p>PNI on diagnostic biopsy is associated with disease progression on confirmatory biopsy.</p> </list-item> <list-item> <p>The presence of PNI should factor into appropriate patient selection and counselling in AS.</p> </list-item> </list> </p> </sec> </abstract>