Perineural invasion as predictor of biochemical recurrence in prostate cancer following open radical prostatectomy: a single-center experience

Purpose To explore the association between perineural invasion (PNI) and biochemical recurrence (BCR) in patients undergoing open radical prostatectomy (ORP). Methods A retrospective observational study was conducted, in which we analyzed patients who underwent ORP at our institution between 2003 and 2020. The biochemical recurrence (BCR)-free survival and overall survival (OS) rates were defined using the Kaplan-Meier method and log-rank analysis. Multivariable Cox-regression models were used to test the effect of other different factors such as preoperative PSA, Gleason score and T stage on biochemical recurrence. The Clavien-Dindo classification was used to report the complication rates. Results In total, 1040 patients were included. PNI was found in 458 (44.1%) and BCR occurred in 212 patients (20.4%) at a median follow-up of 91.2 months. After undergoing the procedure, 216 patients received adjuvant external beam radiotherapy (EBRT). Despite receiving adjuvant treatment, the BCR-free survival was still significantly shorter for PNI-positive patients (mean 32.2 vs. 62.3 months, p < 0.001). The 5- and 10-year BCR-free survival rates for patients without PNI were 90% and 81%, respectively. For the same period of time, BCR-free survival rates for patients with PNI were 75 and 63%, respectively. Therefore, PNI was a strong predictor of BCR (p < 0.001). These results remained even after controlling for established predictors of biochemical recurrence. Limitations include retrospective and single-center study design. Conclusion In conclusion, despite its limitations, our study emphasizes the prognostic importance of PNI in prostate cancer patients. The results demonstrate that the presence of PNI is associated with a high risk of BCR.

Automated summary

This study analyzed 1040 patients undergoing open radical prostatectomy and found a significant association between perineural invasion (PNI) and biochemical recurrence (BCR). Despite receiving adjuvant treatment, patients with PNI had a higher risk of BCR, emphasizing the prognostic importance of PNI in prostate cancer patients.