1500 PROSTATE BIOPSY PERINEURAL INVASION IS NOT INDEPENDENTLY ASSOCIATED WITH POSITIVE SURGICAL MARGINS FOLLOWING OPEN RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized (VII)1 Apr 20131500 PROSTATE BIOPSY PERINEURAL INVASION IS NOT INDEPENDENTLY ASSOCIATED WITH POSITIVE SURGICAL MARGINS FOLLOWING OPEN RADICAL PROSTATECTOMY Benjamin Ristau, Jeffrey Tomaszewski, Yi-Fan Chen, Marnie Bertolet, Elen Woldemichael, and Joel Nelson Benjamin RistauBenjamin Ristau Pittsburgh, PA More articles by this author , Jeffrey TomaszewskiJeffrey Tomaszewski Pittsburgh, PA More articles by this author , Yi-Fan ChenYi-Fan Chen Pittsburgh, PA More articles by this author , Marnie BertoletMarnie Bertolet Pittsburgh, PA More articles by this author , Elen WoldemichaelElen Woldemichael Pittsburgh, PA More articles by this author , and Joel NelsonJoel Nelson Pittsburgh, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2979AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Perineural invasion (PNI) on prostate biopsy (PB) is associated with extracapsular extension (ECE) in radical prostatectomy (RP) specimens. The presence of PNI on PB has led some to advocate resection of the ipsilateral neurovascular bundle (NVB) during surgery. We sought to determine if PB and RP PNI are independently associated with adverse pathological characteristics, positive surgical margins, higher BCR rates, and overall survival after primary treatment with RP. METHODS Prospectively collected data from 2500 patients treated with open RP by a single surgeon from 1999-2011 were reviewed. Patients were categorized into those with and without PNI on PB and RP specimens. Patients were risk stratified using pre-operative PSA level, Gleason grade, and clinical stage. In univariate and adjusted analyses, associations between PNI, clinicopathologic characteristics, and biochemical recurrence (BCR) rates were assessed. BCR was defined as two consecutive PSA levels of 0.2 ng/ml or greater or the use of any adjuvant therapy. RESULTS A bilateral nerve-sparing technique was used in 92% of patients. In unadjusted univariate analyses, PB PNI was significantly associated with Gleason score (p<0.001), clinical stage (p<0.001), positive surgical margins (p<0.001), ECE (p<0.001), seminal vesicle invasion (p<0.001), nodal status (p<0.001), and BCR (p < 0.001). On multivariate analysis, organ confinement (p<0.001), ECE (p<0.001), seminal vesicle invasion (p=0.022), and BCR (p=0.021) remained associated with biopsy PNI. Biopsy PNI was not associated with positive margins at RP (OR 1.3, 0.92-1.9; p=0.13), however the presence of PNI on RP specimens conferred a greater than 4 times increased risk of positive margins (OR 4.6, 2.3-9.2; p<0.001). Men with PNI on PB were 1.5 times more likely to experience BCR (OR 1.5, 1.1-2.0; p=0.021). PNI on PB or RP specimens was not associated with overall survival. CONCLUSIONS In men undergoing open RP for clinically localized prostate adenocarcinoma, PB PNI is associated with an increased risk of BCR. Despite NVB preservation in the majority of men, PNI on PB was not independently associated with positive surgical margins. The presence of PNI on PB should not preclude utilization of a nerve-sparing approach. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e615 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Ristau Pittsburgh, PA More articles by this author Jeffrey Tomaszewski Pittsburgh, PA More articles by this author Yi-Fan Chen Pittsburgh, PA More articles by this author Marnie Bertolet Pittsburgh, PA More articles by this author Elen Woldemichael Pittsburgh, PA More articles by this author Joel Nelson Pittsburgh, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...