Brett Delahunt1, Judith D Murray1, Allison Steigler2, Chris Atkinson3, David Christie4, Gillian Duchesne5, Lars Egevad6, David Joseph7, John Matthews8, Christopher Oldmeadow9, Hemamali Samaratunga10, Nigel A Spry11, John R Srigley12, Hubert Hondermarck9,13, James W Denham2. 1. Department of Pathology and Molecular Medicine and Health Sciences, University of Otago, Wellington, New Zealand. 2. School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia. 3. St Georges Cancer Care Centre, Christchurch, New Zealand. 4. Genesis Care, Tugan, Queensland, Australia. 5. Peter MacCallum Cancer Centre, University of Melbourne, Victoria, Australia. 6. Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden. 7. Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. 8. Auckland City Hospital, Auckland, New Zealand. 9. Hunter Medical Research Institute, Newcastle, New South Wales, Australia. 10. Aquesta Uropathology and University of Queensland, Brisbane, Queensland, Australia. 11. GenesisCare, Perth, Western Australia, Australia. 12. Department of Laboratory Medicine and Pathobiology and Molecular Medicine, University of Toronto, Toronto, ON, Canada. 13. School of Biomedical Sciences and Pharmacy, University of Newcastle, New South Wales, Australia.
Abstract
AIMS: Perineural invasion (PNI) by prostatic adenocarcinoma is debated as a prognostic parameter. This study investigates the prognostic predictive value of PNI in a series of patients with locally advanced prostate cancer treated with radiotherapy and androgen deprivation using 10 years outcome data from the TROG 03.04 RADAR trial. METHODS: Diagnostic prostate biopsies from 976 patients were reviewed and the presence of PNI noted. Patients were followed for 10 years according to the trial protocol or until death. The primary endpoint for the study was time to bone metastasis. Secondary endpoints included time to soft tissue metastasis, transition to castration resistance, prostate cancer-specific mortality and all-cause mortality. RESULTS: PNI was detected in 449 cases (46%), with 234 cases (24%) having PNI in more than one core. The presence of PNI was significantly associated with higher ISUP grade, clinical T staging category, National Comprehensive Cancer Network risk group, and percent positive biopsy cores. The cumulative probability of bone metastases according to PNI status was significant over the 10 years follow-up interval of the study (log-rank test P < 0.0001). PNI was associated with all endpoints on univariable analysis. After adjusting for baseline clinicopathological and treatment factors, bone metastasis was the only endpoint in which PNI retained its prognostic significance (hazard ratio 1.42, 95% confidence interval 1.05-1.92, P = 0.021). CONCLUSIONS: The association between PNI and the development of bone metastases supports the inclusion of this parameter as a component of the routine histology report. Further this association suggests that evaluation of PNI may assist in selecting those patients who should be monitored more closely during follow-up.
AIMS: Perineural invasion (PNI) by prostatic adenocarcinoma is debated as a prognostic parameter. This study investigates the prognostic predictive value of PNI in a series of patients with locally advanced prostate cancer treated with radiotherapy and androgen deprivation using 10 years outcome data from the TROG 03.04 RADAR trial. METHODS: Diagnostic prostate biopsies from 976 patients were reviewed and the presence of PNI noted. Patients were followed for 10 years according to the trial protocol or until death. The primary endpoint for the study was time to bone metastasis. Secondary endpoints included time to soft tissue metastasis, transition to castration resistance, prostate cancer-specific mortality and all-cause mortality. RESULTS: PNI was detected in 449 cases (46%), with 234 cases (24%) having PNI in more than one core. The presence of PNI was significantly associated with higher ISUP grade, clinical T staging category, National Comprehensive Cancer Network risk group, and percent positive biopsy cores. The cumulative probability of bone metastases according to PNI status was significant over the 10 years follow-up interval of the study (log-rank test P < 0.0001). PNI was associated with all endpoints on univariable analysis. After adjusting for baseline clinicopathological and treatment factors, bone metastasis was the only endpoint in which PNI retained its prognostic significance (hazard ratio 1.42, 95% confidence interval 1.05-1.92, P = 0.021). CONCLUSIONS: The association between PNI and the development of bone metastases supports the inclusion of this parameter as a component of the routine histology report. Further this association suggests that evaluation of PNI may assist in selecting those patients who should be monitored more closely during follow-up.
Authors: Michelle R Downes; John R Srigley; Andrew Loblaw; Nathan Perlis; Sangeet Ghai; Theodorus van der Kwast Journal: Can Urol Assoc J Date: 2022-04 Impact factor: 1.862
Authors: Lars Egevad; Brett Delahunt; Hemamali Samaratunga; Toyonori Tsuzuki; Henrik Olsson; Peter Ström; Cecilia Lindskog; Tomi Häkkinen; Kimmo Kartasalo; Martin Eklund; Pekka Ruusuvuori Journal: Virchows Arch Date: 2021-02-03 Impact factor: 4.064
Authors: Kimmo Kartasalo; Peter Ström; Pekka Ruusuvuori; Hemamali Samaratunga; Brett Delahunt; Toyonori Tsuzuki; Martin Eklund; Lars Egevad Journal: Virchows Arch Date: 2022-04-21 Impact factor: 4.535