Back to 2025 Abstracts
MRI Fusion Biopsy Era: Perineural Invasion Not Associated with Upgrading in Low-Risk Prostate Cancer
Nethusan Sivanesan, BS, Gabriela M. Diaz, MD, Sebastian Strachan, MD, Keervani Kandala, BS, Xiwen Zhao, MSPH, Wei S. Tan, MD PhD, Michael S. Leapman, MD, MHS, Preston C. Sprenkle, MD.
Yale School of Medicine, New Haven, NC, USA.
BACKGROUND: Perineural invasion (PNI) has been shown to be an independent predictor for prostate cancer (PCa) aggression in the transrectal ultrasound (TRUS) biopsy era. The objective of this study is to determine whether PNI is independently associated with Gleason score upgrade during active surveillance (AS), among patients undergoing MRI-US fusion biopsy.
METHODS: Our cohort included patients diagnosed with Gleason Grade Group (GGG) 1 disease on diagnostic biopsy who underwent one or more subsequent prostate biopsies during their follow up. Demographics, MRI and biopsy information, and additional clinical characteristics were recorded. Univariate and multivariate logistic regression models were used to assess the association between PNI and upgrading to GGG2+ disease on subsequent biopsy in models adjusted for clinical variables.
RESULTS: Among 325 patients with Grade Group 1 (GGG1) prostate cancer on diagnostic biopsy, 51 (15%) had perineural invasion (PNI) and 274 (84%) did not. Gleason upgrading on subsequent biopsy occurred in 110 patients (34%), including 24 of 51 (47%) with PNI and 86 of 274 (32%) without (p=0.03). On univariate analysis, PNI (OR 1.94, p=0.03), number of positive cores (OR 1.13, p=0.007), presence of a PI-RADS 4 or 5 lesion (OR 2.6, p<0.001), and cancer detected on targeted MRI-fusion biopsy core (OR 2.6, p<0.001) were significantly associated with upgrading to ≥GGG2. However, on multivariate analysis, only PI-RADS 4 or 5 lesions (OR 1.98, p=0.01), cancer on targeted core (OR 2.26, p=0.01), and African American race (OR 3.2, p=0.01) remained independent predictors. PNI was not independently associated with upgrading (OR 1.84, p=0.1).
CONCLUSIONS:In this contemporary series of patients managed with AS in the era of MRI-ultrasound fusion biopsy, PNI is not associated with Gleason upgrade on subsequent biopsy when adjusting for MRI-US fusion biopsy characteristics.
Back to 2025 Abstracts
