Comparison of EAU Risk Group in Patients Undergoing Radical Prostatectomy According to the Status of Perineural Invasion

Abstract

Background and purpose: The classification of prostate cancer patients based on the criteria of the European Urology Association, based on the level of a prostate-specific antigen, digital rectal examination, and Gleason score, is one of the golden criteria for the prognosis of the disease. On the other hand, it seems that in aggressive forms of the disease, cancer cells can spread along nerve cells, which is called perineurial invasion. The relationship between prostate cancer classification criteria and disease recurrence or survival is well known, but the importance of perineurial invasion in the prognosis of the disease is less discussed and investigated, so this study aims to compare two groups of positive and negative perineurial invasion. It is based on the EAU risk classification to investigate the difference between the two groups in terms of disease prognosis. Materials and methods: This retrospective study was conducted on 200 prostate cancer patients who underwent radical prostatectomy in Babol University of Medical Sciences affiliated hospitals between 1396 and 1400. Inclusion criteria included prostate cancer and, the presence of clinical and pathology test results. The exclusion criterion was the patient suffering from all types of prostate cancer, other than adenocarcinoma. All the demographic, paraclinical, clinical, and pathology data of the patients were obtained using the data recorded in the patient's pathology file as well as the hospital's archive department. Patients' information was extracted from patient files using a checklist including age, results of PSA, DRE, TNM, and Gleason scores, as well as the patient's condition in terms of peripheral nerve invasion. Gleason score is the standard criterion for histological differentiation of prostate cancer, which is graded from 2 to 10 points. A score less than 7 indicates better differentiation, a score of 7 indicates moderate differentiation, and a Gleason score of 8, 9, or 10 indicates poor differentiation of prostate cells. The study data were analyzed using SPSS version 20 software. was analyzed. Chi2 and Fisher Exact tests were used to analyze the data, and independent t-test (to compare two groups) and ANOVA (to compare more than two groups) were used to compare the mean of quantitative variables. Results: The average age of the subjects under study was 67.13±5.91. By classifying patients according to EAU risk groups, and comparing the risk class between patients with positive and negative perineurial invasion based on PSA, DRE, TNM, and Gleason score statistically significant differences were seen between the two groups. In almost all classifications based on clinicopathological scales, patients with positive perineurial invasion were at higher risk in terms of EAU criteria than patients with negative perineurial invasion. Conclusion: The results of the study showed that positive perineurial invasion in prostate cancer patients can be considered as a poor prognosis of the disease. The presence of cancer cells in the perineurial space can be an early sign of cancer progression

Keywords

• cancer
• prostate
• perineurial invasion
• gleason
• european association urology