Perineural Invasion's Role in Prostate Cancer Progression

In this study, the researchers investigated whether perineural invasion (PNI) predicts an increase in the Gleason score, a measure of prostate cancer severity, during active monitoring of patients. They focused on patients initially diagnosed with low-risk prostate cancer, known as Gleason Grade Group 1 (GGG1), who underwent MRI-ultrasound (MRI-US) fusion biopsies. The authors aimed to determine if PNI remains a significant factor in predicting cancer progression in this modern diagnostic context.

Understanding the role of PNI in prostate cancer progression is crucial because it could influence how patients are monitored and treated. Prostate cancer is the most common cancer in men in the United States, with a wide range of potential outcomes. If PNI is a reliable predictor of cancer progression, it could help doctors identify patients who might require more aggressive treatment earlier. This study's findings could affect clinical guidelines and improve patient outcomes by refining surveillance strategies.

The researchers conducted a retrospective analysis of 325 patients with GGG1 prostate cancer. All participants had undergone at least two MRI-US fusion biopsies. The study collected data on various factors, such as age, race, and biopsy results, to assess the association between PNI and Gleason score upgrading. Statistical analyses, including univariate and multivariate logistic regression, were used to identify predictors of cancer progression.

The study found that 15% of patients had PNI, and 34% experienced a Gleason score upgrade. However, PNI was not an independent predictor of upgrading when other factors were considered. Instead, a high PI-RADS score, which indicates more suspicious lesions on MRI, and cancer detected in MRI-visible areas were stronger predictors of progression. Additionally, African American race was associated with a higher likelihood of upgrading.

These findings suggest that while PNI is not an independent risk factor for prostate cancer progression in patients undergoing MRI-US fusion biopsies, other factors like PI-RADS scores and targeted biopsy results are more indicative of potential upgrading. This could shift focus toward these factors in clinical assessments, potentially improving the management of low-risk prostate cancer.

The authors recommend further research in larger, more diverse populations to validate these findings. Future studies should also explore the integration of genomic data to better understand the biological mechanisms through which PNI might influence prostate cancer progression.

Yale University provided funding and support for this research.