Correlation of Perineural Invasion on Radical Prostatectomy Specimens with Other Pathologic Prognostic Factors and PSA Failure

Objective: The aim of this study is to evaluate the relationship between perineural invasion (PNI) and other pathologic prognostic factors in radical retropubic prostatectomy (RRP) specimens and also to assess the role of PNI in prostate–specific antigen (PSA) recurrence after RRP. Method: 191 consecutive patients had undergone RRP for clinically localized prostate cancer between 1992 and 2000. PNI in RRP specimens and its relation to histopathologic stage and surgical margins is investigated retrospectively. PNI, histopathologic stage, surgical margin status, Gleason score and PSA parameters were used as variables in multivariate analysis for recurrence. Results: PNI is correlated statistically significantly with histopathologic stage, positive surgical margins, specimen Gleason score and recurrence. Mean time to failure was earlier in patients with PNI than patients without PNI (56 vs. 73 months, log–rank 15.67, p<0.001). Lymph node involvement, positive surgical margins and PNI remained as independent predictors of recurrence in multivariate analysis. All patients with PNI, positive surgical margins and lymph node metastasis failed in 6 months. Conclusion: PNI is an important prognostic factor that should be taken into consideration in clinical patient management and follow–up after RRP. The presence of PNI together with positive surgical margins and lymph node metastasis may warrant early adjuvant treatment.