Can perineural invasion on prostate needle biopsy predict prostate specific antigen recurrence after radical prostatectomy?

Purpose: We evaluated the role of perineural invasion identified on prostat e needle biopsy as a predictor of prostate specific antigen (PSA) recurrenc e after radical prostatectomy. Materials and Methods: Between 1993 and 1998 radical prostatectomy was perf ormed in 319 consecutive patients. Prostate needle biopsies were reviewed i n all cases. We compared perineural invasion with other preoperative parame ters, including digital rectal examination, PSA and biopsy Gleason score, f or the ability to predict PSA recurrence with recurrence defined as any ser um PSA level greater than 0.2 ng./ml. Results: Perineural invasion was identified on 77 of 319 preoperative prost ate biopsies (24%). There was PSA recurrence in 46 patients (14.4%) at a me an followup of 25.4 months (range 0.2 to 62.1). Perineural invasion statist ically correlated with PSA recurrence. Kaplan-Meier analysis revealed disea se-free survival rates of 24 versus 64% when perineural invasion was and wa s not present in the prostate biopsy (p = 0.0003, log rank 12.92). Multivar iate analysis demonstrated that perineural invasion (p = 0.012) and PSA (p = 0.005) were independent preoperative predictive factors of PSA recurrence . When perineural invasion was compared with postoperative parameters, incl uding disease stage, surgical margins and seminal vesicle invasion, it was not an independent predictor because it closely correlated with tumor stage . Conclusions: Perineural invasion on preoperative prostate needle biopsy is a strong independent predictor of PSA recurrence in patients in whom prosta te cancer was treated with radical prostatectomy.