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Vol. 46. Issue 6.
Pages 377-384 (July - August 2022)
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Vol. 46. Issue 6.
Pages 377-384 (July - August 2022)
Original article
The association between perineural invasion in mpMRI-targeted and/or systematic prostate biopsy and adverse pathological outcomes in robot-assisted radical prostatectomy
Asociación entre la invasión perineural en la biopsia de próstata dirigida por RMmp y/o sistemática y los resultados patológicos adversos en la prostatectomía radical asistida por robot
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N. Karsiyakalia,
Corresponding author
nkarsiyakali@hotmail.com

Corresponding author.
, M. Bulent Ozgena, B. Ozverenb, C. Akbalb, A. Dincerc, H. Durakd, L. Turkeria
a Department of Urology, Altunizade Hospital, Acibadem M. A. Aydinlar University, Istanbul, Turkey
b Department of Urology, Altunizade Hospital, School of Medicine, Acibadem M. A. Aydinlar University, Istanbul, Turkey
c Department of Radiology, Altunizade Hospital, School of Medicine, Acibadem M. A. Aydinlar University, Istanbul, Turkey
d Clinical Pathology Laboratory, Altunizade Hospital, Acibadem M. A. Aydinlar University, Istanbul, Turkey
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Abstract
Introduction and objectives

This study aims to investigate the relationship between perineural invasion (PNI) in targeted (TBx) and/or systematic (SBx) prostate needle biopsy and adverse pathological features of prostate cancer (PCa) in prostatectomy specimens.

Materials and methods

A total of 95 male patients who underwent transperineal TBx and/or concomitant SBx subsequently treated with robot-assisted radical prostatectomy for PCa between October 2015 and June 2020 were included. The performance of PNI as a classification test (sensitivity, specificity, positive and negative predictive values) and its correlation with clinically significant PCa, surgical margin positivity, extraprostatic extension, and seminal vesicle invasion in prostatectomy were computed.

Results

The median age of the patients was 65 (60-70) years. TBx and concomitant SBx were performed in 78 (82.1%) patients, while 16 (16.8%) patients underwent SBx alone and one (1.1%) patient underwent TBx alone. The frequency of PNI in TBx and SBx was 17 (21.5%) and 32 (34.0%), respectively. The specificity/negative predictive values of PNI for surgical margin positivity, extraprostatic extension, and seminal vesicle invasion were 79.7/88.7%, 92.5/79.0%, and 83.3/96.8%, in TBx, and 71.1/87.1%, 80.7/74.2%, and 69.5/91.9%, in SBx, respectively. There was also a statistically significant correlation between PNI in biopsy and surgical margin positivity, extraprostatic extension, and seminal vesicle invasion in prostatectomy as well as the ISUP grade group and pT stage.

Conclusions

The absence of PNI in prostate needle biopsy may predict localized PCa with a pT stage ≤ 2c and negative surgical margins in contrast to its presence which appears to be an indicator of unfavorable factors in final pathology.

Keywords:
Extraprostatic extension
mpMRI/TRUS fusion prostate biopsy
Perineural invasion
Seminal vesicle invasion
Radical prostatectomy
Resumen
Introducción y objetivos

Este estudio tiene como objetivo investigar la relación entre la invasión perineural (IPN) en la biopsia de próstata con aguja dirigida (BD) y/o sistemática (BS) y las características patológicas adversas del cáncer de próstata (CaP) en los especímenes de prostatectomía.

Materiales y métodos

Se incluyeron un total de 95 pacientes varones que recibieron una BD transperineal y/o una BS concomitante, tratados posteriormente con prostatectomía radical asistida por robot para CaP entre octubre de 2015 y junio de 2020. Se calculó el rendimiento de la IPN como prueba de clasificación (sensibilidad, especificidad, valores predictivos positivos y negativos) y su correlación con el CaP clínicamente significativo, la positividad del margen quirúrgico, la extensión extraprostática y la invasión de las vesículas seminales en la prostatectomía.

Resultados

La edad media de los pacientes era 65 (60-70) años. Se realizó BD y BS concomitante en 78 (82,1%) pacientes, mientras que 16 (16,8%) pacientes recibieron solo BS y uno (1,1%) solo BD. La frecuencia de IPN en la BD y BS fue de 17 (21,5%) y 32 (34,0%), respectivamente. Los valores de especificidad/predictivos negativos de la IPN para positividad del margen quirúrgico, extensión extraprostática e invasión de las vesículas seminales fueron 79,7/88,7%, 92,5/79,0% y 83,3/96,8%, en la BD, y 71,1/87,1%, 80,7/74,2% y 69,5/91,9%, en la BS, respectivamente. También hubo una correlación estadísticamente significativa entre la IPN en la biopsia y la positividad del margen quirúrgico, la extensión extraprostática y la invasión de las vesículas seminales en la prostatectomía, así como en cuanto al grupo de grado ISUP y el estadio pT.

Conclusiones

La ausencia de IPN en la biopsia de próstata con aguja puede predecir un CaP localizado con un estadio pT ≤ 2c y márgenes quirúrgicos negativos; por el contrario, su presencia parece ser un indicador de factores desfavorables en la patología final.

Palabras clave:
Extensión extraprostática
Biopsia de próstata por fusión RMmp/ecografía
Invasión perineural
Invasión vesículas seminales
Prostatectomía radical

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