Baseline Perineural Invasion is Associated with Shorter Time to Progression in Men with Prostate Cancer Undergoing Active Surveillance: Results from the REDEEM Study

No AccessJournal of UrologyAdult Urology1 Nov 2015Baseline Perineural Invasion is Associated with Shorter Time to Progression in Men with Prostate Cancer Undergoing Active Surveillance: Results from the REDEEM Study Daniel M. Moreira, Neil E. Fleshner, and Stephen J. Freedland Daniel M. MoreiraDaniel M. Moreira Department of Urology, Mayo Clinic, Rochester, Minnesota , Neil E. FleshnerNeil E. Fleshner Division of Urology, Princess Margaret Hospital, University Health Network and Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada , and Stephen J. FreedlandStephen J. Freedland Division of Urology, Department of Surgery and the Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, California Urology Section, Veterans Affairs Medical Center, Durham, North Carolina View All Author Informationhttps://doi.org/10.1016/j.juro.2015.04.113AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We evaluated the association of perineural invasion with disease progression in men with prostate cancer on active surveillance. Materials and Methods: We retrospectively analyzed the records of 302 men on active surveillance for low risk prostate cancer (T1c-T2a), Gleason 6 or less, 3 or fewer positive cores, 50% or less of any core involved and prostate specific antigen 11 ng/ml or less in the REduction by Dutasteride of clinical progression Events in Expectant Management (REDEEM) study. Patients underwent study mandated biopsies 18 and 36 months after enrollment. Disease progression was divided into pathological (4 or greater positive cores, 50% or greater core involvement, or Gleason greater than 6 on followup biopsy), therapeutic (any therapeutic prostate cancer intervention) or clinical (pathological or therapeutic progression). Time to disease progression was analyzed with Cox models adjusting for patient age, race, baseline prostate specific antigen, number of sampled and involved cores, tumor length and treatment. Results: A total of 11 patients (4%) had perineural invasion on baseline biopsy. Perineural invasion was not associated with any baseline features (each p >0.05). During the study clinical progression developed in 125 patients (41%), including pathological progression in 95. One, 2 and 3-year clinical progression-free survival for men with vs without perineural invasion was 82%, 27% and 27% vs 93%, 67% and 58%, respectively (p <0.05). On multivariable analyses perineural invasion was associated with clinical (HR 2.39, 95% CI 1.16–4.94, p = 0.019) and pathological progression (HR 2.21, 95% CI 0.92–5.33, p = 0.076). Conclusions: Among patients with prostate cancer on active surveillance perineural invasion was associated with an increased risk of clinical progression. The 2-year risk of clinical progression with perineural invasion was 73%. If these results are confirmed, patients with perineural invasion may not be good active surveillance candidates. References 1 : Biological significance of perineural invasion (PNI) in prostate cancer. Prostate2012; 72: 542. Google Scholar 2 : Perineural invasion in cancer: a review of the literature. Cancer2009; 115: 3379. Google Scholar 3 : Perineural invasion on prostate needle biopsy: an independent predictor of final pathologic stage. Urology1999; 54: 1039. 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Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byde la Calle C, Mamawala M, Landis P, Macura K, Trock B, Epstein J and Pavlovich C (2022) Clinical Significance of Perineural Invasion in Men With Grade Group 1 Prostate Cancer on Active SurveillanceJournal of Urology, VOL. 209, NO. 1, (180-186), Online publication date: 1-Jan-2023.de la Taille A (2015) Sometimes a Simple Old-Fashioned and Low Cost Pathological Parameter Can be UsefulJournal of Urology, VOL. 194, NO. 5, (1187-1187), Online publication date: 1-Nov-2015.Smith J (2015) This Month in Adult UrologyJournal of Urology, VOL. 194, NO. 5, (1181-1182), Online publication date: 1-Nov-2015. Volume 194Issue 5November 2015Page: 1258-1263Supplementary Materials Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Keywordsprostate-specific antigenprostatic neoplasmsneoplasm invasivenessriskdisease progressionMetricsAuthor Information Daniel M. Moreira Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Neil E. Fleshner Division of Urology, Princess Margaret Hospital, University Health Network and Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada Financial interest and/or other relationship with Amgen, Janssen, Astellas, Bayer, Sanofie, AbbVie, Ferring, Canadian Cancer Society Research Institute and Prostate Cancer Canada. More articles by this author Stephen J. Freedland Division of Urology, Department of Surgery and the Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, California Urology Section, Veterans Affairs Medical Center, Durham, North Carolina More articles by this author Expand All Advertisement PDF downloadLoading ...