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Prediction of Extraprostatic Extension of Prostate Cancer Based on Needle Biopsy Findings: Perineural Invasion Lacks Significance on Multivariate Analysis
BENIGN AND MALIGNANT NEOPLASMS OF THE PROSTATE
prostate cancers have lower free PSA levels 15 years before diagnosis than men with more indolent disease.1.2 Patrick C. Walsh, M.D. 1. Pannek,J., Rittenhouse,H. G., Chan, D. W., Epstein, J. I., Walsh, P. C. and Partin,A. W.: The use of percent free prostate specific antigen for staging clinically localized prostate cancer. J. Urol., 159 1238, 1998. 2. Carter, H.B., Partin, A. W., Luderer, A. A, Metter, E. J., Landis, P., Chan, D. W., Fozard, J. L. and Pearson, J. D.: Percentage of free prostate-specificantigen in sera predicts aggressiveness of prostate cancer a decade before diagnosis. Urology, 4 9 379,1997.
Prediction of Extraprostatic Extension of Prostate Cancer Based on Needle Biopsy Findings: Perineural Invasion Lacks Significance on Multivariate Analysis A. J. M. EGANAND D. G. BOSTWICK, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota Amer. J. Surg. Path., 21: 1496-1500, 1997 Extraprostatic extension (EPE) and seminal vesicle invasion (SVI) are adverse prognostic factors in prostate cancer, and their prediction before prostatectomy would be useful. Perineural invasion in needle biopsy has been advocated as a marker of extraprostatic extension, but its independent value as a predictor of stage has not been established. We studied 349 previously untreated men with prostatic adenocarcinoma who underwent bilateral pelvic lymphadenectomy and radical retropubic prostatectomy. All patients were clinically free of metastases and had cancer that was diagnosed on needle biopsy. Five preoperative variables were collected: clinical stage (TNM staging system), serum prostate-specific antigen (PSA), Gleason score on needle biopsy, presence or absence of perineural invasion, and proportion of the biopsy involved by cancer. The subsequent prostatectomy specimens were completely embedded, and whole mount sections were used to evaluate four outcome staging variables: EPE (absent/present), EPE (absenthnilateralhilateral), seminal vesicle invasion, and pathologic stage (TNM). On univariate analysis, each preoperative variable was significantly associated with each outcome variable except for a lack of association between clinical stage and SVI. Perineural invasion in the biopsy predicted EPE with a sensitivity of 51%, specificity of 70%, positive predictive value of 49%, and negative predictive value of 71%. On multivariate analysis (stepwise logistic regression), only preoperative PSA, proportion of the biopsy involved by cancer, and Gleason score were significant (p <0.05); perineural invasion and clinical stage had no independent predictive value for any of the outcome variables. We conclude that the finding of perineural invasion in needle biopsy of prostatic carcinoma has no independent predictive value for the presence of extraprostatic extension, seminal vesicle involvement, or pathologic stage in the radical prostatectomy. Accordingly, we no longer routinely evaluate this finding in biopsy specimens.
Editorial Comment: These authors suggest that the finding of perineural invasion on needle biopsy has no independent predictive value and recommendthat it should no longer be reported routinely on biopsy specimens. Patrick C. Walsh, M.D.
Watchful Waiting or Watchful Progression? Prostate Specific Antigen Doubling Times and Clinical Behavior in Patients With Early Untreated Prostate Carcinoma D. B. MCLAREN, M. MCKENZIE, G. DUNCAN T. PICKLES, Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada Cancer, 8 2 342-348, 1998 BACKGROUND. Prostate specific antigen doubling time (PSAdt) is a dynamic model of prostate tumor biology. It predicts aggressive disease and subsequent clinical recurrence aRer radical treatment. However, as yet there is only limited evidence for its validity in the watchful waiting population. METHODS. One hundred and thirteen previously untreated patients with adenocarcinoma of the prostate who were referred to the British Columbia Cancer Agency for a management opinion subsequently were placed into a prospective watchful waiting program. The reasons for watchful waiting, previous medical history, serial PSA, and histopathologic data were recorded. RESULTS. The median age of patients was 75 years (range, 49-85 years). The median follow-up from the time of the first appointment was 14 months (range, 0-58 months). The reasons for watchful waiting were correlated highly with T classification (P = 0.003) and past medical history (P = 0.002). Approximately 40% of T1 patients and 51% of T2 patients had clinical progression by 2 years, increasing to 60% at 3 years. On multivariate analysis PSAdt strongly correlated with clinical progression (P
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prostate cancers have lower free PSA levels 15 years before diagnosis than men with more indolent disease.1.2 Patrick C. Walsh, M.D. 1. Pannek,J., Rittenhouse,H. G., Chan, D. W., Epstein, J. I., Walsh, P. C. and Partin,A. W.: The use of percent free prostate specific antigen for staging clinically localized prostate cancer. J. Urol., 159 1238, 1998. 2. Carter, H.B., Partin, A. W., Luderer, A. A, Metter, E. J., Landis, P., Chan, D. W., Fozard, J. L. and Pearson, J. D.: Percentage of free prostate-specificantigen in sera predicts aggressiveness of prostate cancer a decade before diagnosis. Urology, 4 9 379,1997.
Prediction of Extraprostatic Extension of Prostate Cancer Based on Needle Biopsy Findings: Perineural Invasion Lacks Significance on Multivariate Analysis A. J. M. EGANAND D. G. BOSTWICK, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota Amer. J. Surg. Path., 21: 1496-1500, 1997 Extraprostatic extension (EPE) and seminal vesicle invasion (SVI) are adverse prognostic factors in prostate cancer, and their prediction before prostatectomy would be useful. Perineural invasion in needle biopsy has been advocated as a marker of extraprostatic extension, but its independent value as a predictor of stage has not been established. We studied 349 previously untreated men with prostatic adenocarcinoma who underwent bilateral pelvic lymphadenectomy and radical retropubic prostatectomy. All patients were clinically free of metastases and had cancer that was diagnosed on needle biopsy. Five preoperative variables were collected: clinical stage (TNM staging system), serum prostate-specific antigen (PSA), Gleason score on needle biopsy, presence or absence of perineural invasion, and proportion of the biopsy involved by cancer. The subsequent prostatectomy specimens were completely embedded, and whole mount sections were used to evaluate four outcome staging variables: EPE (absent/present), EPE (absenthnilateralhilateral), seminal vesicle invasion, and pathologic stage (TNM). On univariate analysis, each preoperative variable was significantly associated with each outcome variable except for a lack of association between clinical stage and SVI. Perineural invasion in the biopsy predicted EPE with a sensitivity of 51%, specificity of 70%, positive predictive value of 49%, and negative predictive value of 71%. On multivariate analysis (stepwise logistic regression), only preoperative PSA, proportion of the biopsy involved by cancer, and Gleason score were significant (p <0.05); perineural invasion and clinical stage had no independent predictive value for any of the outcome variables. We conclude that the finding of perineural invasion in needle biopsy of prostatic carcinoma has no independent predictive value for the presence of extraprostatic extension, seminal vesicle involvement, or pathologic stage in the radical prostatectomy. Accordingly, we no longer routinely evaluate this finding in biopsy specimens.
Editorial Comment: These authors suggest that the finding of perineural invasion on needle biopsy has no independent predictive value and recommendthat it should no longer be reported routinely on biopsy specimens. Patrick C. Walsh, M.D.
Watchful Waiting or Watchful Progression? Prostate Specific Antigen Doubling Times and Clinical Behavior in Patients With Early Untreated Prostate Carcinoma D. B. MCLAREN, M. MCKENZIE, G. DUNCAN T. PICKLES, Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada Cancer, 8 2 342-348, 1998 BACKGROUND. Prostate specific antigen doubling time (PSAdt) is a dynamic model of prostate tumor biology. It predicts aggressive disease and subsequent clinical recurrence aRer radical treatment. However, as yet there is only limited evidence for its validity in the watchful waiting population. METHODS. One hundred and thirteen previously untreated patients with adenocarcinoma of the prostate who were referred to the British Columbia Cancer Agency for a management opinion subsequently were placed into a prospective watchful waiting program. The reasons for watchful waiting, previous medical history, serial PSA, and histopathologic data were recorded. RESULTS. The median age of patients was 75 years (range, 49-85 years). The median follow-up from the time of the first appointment was 14 months (range, 0-58 months). The reasons for watchful waiting were correlated highly with T classification (P = 0.003) and past medical history (P = 0.002). Approximately 40% of T1 patients and 51% of T2 patients had clinical progression by 2 years, increasing to 60% at 3 years. On multivariate analysis PSAdt strongly correlated with clinical progression (P
1581