BERKELEY, CA (UroToday.com) - In our study, we performed a systematic review of the literature in order to assess the relationship between the presence of perineural invasion (PNI) at prostate biopsy and extraprostatic extension (EPE) of prostate cancer. At univariate analysis, PNI showed a statistically significant association with pT3 tumors (p < 0.00001). The main limitation of our analysis was the impossibility to perform a multivariate analysis; thus, our results cannot be considered definitive evidence that PNI alone is predictive of EPE, but they suggest that the presence of PNI should be considered in the decision making for the surgical treatment of prostate cancer between other features, such as Gleason score, iPSA, number of cores, clinical staging, etc.
Recent evidences highlighted the importance of predicting EPE. Predicting EPE is of great importance in patients with high-risk prostate cancers, as Abdollah et al. showed that high-risk prostate cancer benefits the most from radical prostatectomy,[1] and so every effort should be made for avoiding positive surgical margins.
Furthermore, the Pasadena Consensus Panel (PCP) standardized the concept of different degrees of nerve-sparing and proposed partial preservation of the neurovascular bundles limited to the side with organ-confined disease, or no disease, in patients with monolateral EPE.[2]
In conclusion, as radical surgery for prostate cancer develops, it becomes more and more important to gain an accurate prediction of the risk category of each patient in order to avoid over- and under-treatment. We still do not have adequate instruments to predict EPE, and this remains one of the most important topics where research is needed.
References:
- F, Maxine S, Schmitges J, Thuret R, Bianchi M, Shariat SF, Briganti A, Jeidres C, Perrotte P, Montorsi F, Karakiewicz P. Survival benefit of radical prostatectomy in patients with localized prostate cancer: estimations of the number needed to treat according to tumor and patient characteristics. J Urol. 2012 Jul;188(1):73-83.
- Montorsi F, Wilson TG, Rosen RC, Ahlering TE, Artibani W, Carroll PR, Costello A, Eastham JA, Ficarra V, Guazzoni G, Menon M, Novara G, Patel VR, Stolzenburg JU, Van der Poel H, Van Poppel H, Mottrie A. Best Practices in Robot-assisted Radical Prostatectomy: Recommendations of the Pasadena Consensus Panel. Eur Urol. 2012;62(3):368-81.
Written by:
Gabriele Cozzi, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Università degli Studi di Milano. Clinica Urologica I. Fondazione IRCCS Ca’ Granda - Ospedale
Maggiore Policlinico, Milan, Italy.
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