OBJECTIVE: To determine the importance of PNI in men on diagnostic biopsy in men enrolled in active surveillance (AS).
PATIENTS AND METHODS: Eligibility criteria for AS included clinical-stage ≤T2a and Gleason score ≤ 6, ≤ 3 cores positive, maximum single core involvement < 50%, and total tumor volume ≤ 5% on diagnostic biopsy. All men received 12-core confirmation biopsy within 6 months. AS "failure" on confirmatory biopsy was defined as failure to meet one or more eligibility criteria. Risk of AS failure was compared in men with and without PNI.
RESULTS: For the 165 men comprising the study population, the mean age and median PSA of men at study entry were 66.9±6.5 years and 4.4 ng/mL (IQR 3.2-6.0). Median follow was 5.5 months (IQR 1.1-9.9). 8.5% of men had PNI on diagnostic biopsy. Compared to those without PNI, men with PNI tended to have a higher mean number of cores involved (2.0±0.7 vs. 1.6±0.8; p=0.08) but did not have significantly greater mean total tumor length (3.0±2.1mm vs. 2.3±3.6mm; p=0.27) on diagnostic biopsy. Men with PNI on diagnostic biopsy were significantly more likely to meet criteria for disease progression on confirmatory biopsy (57% vs. 21%; p=0.006). PNI remained a significant predictor for AS failure after adjustment for number of positive cores, maximum percent core involvement, and total tumor length (OR 4.4, 95% CI 1.4-14.2).
CONCLUSION: PNI on diagnostic biopsy is associated with disease progression on confirmatory biopsy. The presence of PNI should factor into appropriate patient selection and counseling in AS.
Written by:
Cohn JA, Dangle PP, Wang CE, Brendler CB, Novakovic KR, McGuire MS, Helfand BT. Are you the author?
Section of Urology, University of Chicago, Chicago, IL.
Reference: BJU Int. 2013 Sep 20. Epub ahead of print.
doi: 10.1111/bju.12463
PubMed Abstract
PMID: 24106869
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