The relationship between early biochemical failure and perineural invasionin pathological T2 prostate cancer

Objectives To evaluate, in patients with pathologically localized prostate cancer, the relationship between early biochemical failure, i.e. an increas ing prostate-specific antigen (PSA) level, and perineural invasion (PNI) on final pathology. Patients and methods The records were reviewed of 171 patients with prostat e cancer who underwent prostatectomy atone institution between January 1992 and December 1995. Data on the histology, therapy and PSA level were colle cted and evaluated. Results Of the 171 patients with pathologically localized (pT2) prostate ca ncer, 131 were evaluable; 17 (13%) had a detectable PSA level in the first 5 years after surgery and 63 had PNI in the pathological specimen. Of those with PSA recurrence, 24 had PNI, one had no PNI and in two there was no co mment on PNI. In comparison, only 10 of the 17 patients with recurrence had a Gleason sum of greater than or equal to 7. Conclusion Perineural invasion seems to be an important predictor of early outcome in patients with organ-confined prostate cancer treated by prostate ctomy. In this series it was the most sensitive predictor of biochemical fa ilure. A more detailed pathological evaluation of prostate cancer may allow the clinician to provide closer surveillance and better informed clinical decision-making.