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Evidence of increased failure in the treatment of prostate carcinoma patients who have perineural invasion treated with three‐dimensional conformal radiation therapy
BACKGROUND The detection of perineural invasion (PNI) in the diagnostic transrectal biopsy of the prostate is associated with a 93% frequency of extracapsular disease extension in patients treated by prostatectomy for adenocarcinoma of the prostate. Extracapsular extension is associated with an infe...
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| Published in: | Cancer 1997-01, Vol.79 (1), p.75-80 |
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| container_title | Cancer |
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| creator | Bonin, Steven R. Hanlon, Alexandra L. Lee, W. Robert Movsas, Benjamin Al‐Saleem, T. I. Hanks, Gerald E. |
| description | BACKGROUND
The detection of perineural invasion (PNI) in the diagnostic transrectal biopsy of the prostate is associated with a 93% frequency of extracapsular disease extension in patients treated by prostatectomy for adenocarcinoma of the prostate. Extracapsular extension is associated with an inferior outcome compared with that of patients who have organ‐confined disease. This study examined the association of PNI and treatment failure in a consecutive series of patients treated with three‐dimensional conformal radiation therapy (3DCRT) alone.
METHODS
The authors report actuarial biochemical no evidence of disease (bNED) survival rates for 484 consecutive patients with clinically localized prostate carcinoma diagnosed by transrectal needle biopsy who completed 3DCRT alone between May 1989 and December 1994. The median follow‐up time was 28 months (range, 2‐75 months), and the median dose to the center of the prostate was 7368 centigray (cGy) (range, 6316‐8074 cGy). Patients were subdivided into 2 groups according to pretreatment prostate specific antigen (PSA) levels ( |
| doi_str_mv | 10.1002/(SICI)1097-0142(19970101)79:1<75::AID-CNCR11>3.0.CO;2-3 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_78787441</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>78787441</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4761-80f2c22c3c5e1c3747e107491ff93c09d4f3f3ab180978edd034c99b517c45db3</originalsourceid><addsrcrecordid>eNqFkduO0zAQhiMEWsrCIyDlAqHdixQfknXcRaBVWKDSikocBFxZrjNWjXIodtKqdzwCb8F78SRMSOgNSMiSDzO_P4_nj6LnlMwpIezJ2btlsTynRIqE0JSdUSkFoYSeC7mgT0W2WFwtXyTFm-Itpc_4nMyL1SVL-K1odrxzO5oRQvIkS_mnu9G9EL7gUbCMn0QnucxzweQs-nG9cyU0BuLWxq4xHnSAMrbaVb0HjMTdBuIOw10NTTeotr4Nne4gNtob17S1jre6c5gN8X7Txhu9g3gL3jXQe10hY6eDa5uRgvC96zaI9QA_v30vHXKHNCpN29jW17jzunTIbH8_7_X2cD-6Y3UV4MG0nkYfXl6_L14nN6tXy-LqJjGpuKBJTiwzjBluMqCGi1QAJSKV1FrJDZFlarnlek1z7FIOZUl4aqRcZ1SYNCvX_DR6PHLxl197CJ2qXTBQVbqBtg9K5DjSlKLw4yg02I7gwaqtd7X2B0WJGixUarBQDXaowQ71x0IlpMIpUwotVKOFiiuiipViiiP54VRCv66hPHInzzD_aMrrYHRlvW6MC0cZyxjLL3KUfR5le1fB4a_q_lfcP2ubIvwXfp7JvA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>78787441</pqid></control><display><type>article</type><title>Evidence of increased failure in the treatment of prostate carcinoma patients who have perineural invasion treated with three‐dimensional conformal radiation therapy</title><source>Wiley</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Bonin, Steven R. ; Hanlon, Alexandra L. ; Lee, W. Robert ; Movsas, Benjamin ; Al‐Saleem, T. I. ; Hanks, Gerald E.</creator><creatorcontrib>Bonin, Steven R. ; Hanlon, Alexandra L. ; Lee, W. Robert ; Movsas, Benjamin ; Al‐Saleem, T. I. ; Hanks, Gerald E.</creatorcontrib><description>BACKGROUND
The detection of perineural invasion (PNI) in the diagnostic transrectal biopsy of the prostate is associated with a 93% frequency of extracapsular disease extension in patients treated by prostatectomy for adenocarcinoma of the prostate. Extracapsular extension is associated with an inferior outcome compared with that of patients who have organ‐confined disease. This study examined the association of PNI and treatment failure in a consecutive series of patients treated with three‐dimensional conformal radiation therapy (3DCRT) alone.
METHODS
The authors report actuarial biochemical no evidence of disease (bNED) survival rates for 484 consecutive patients with clinically localized prostate carcinoma diagnosed by transrectal needle biopsy who completed 3DCRT alone between May 1989 and December 1994. The median follow‐up time was 28 months (range, 2‐75 months), and the median dose to the center of the prostate was 7368 centigray (cGy) (range, 6316‐8074 cGy). Patients were subdivided into 2 groups according to pretreatment prostate specific antigen (PSA) levels (<20 ng/mL vs. ≥20 ng/mL). Pathology records were reviewed for the presence or absence of PNI. bNED failure was defined as a PSA level ≥ 1.5 ng/mL and rising on 2 consecutive occasions. bNED survival rates were calculated using Kaplan‐Meier methodology and comparisons of survival curves were accomplished using the log rank test.
RESULTS
The 3‐year bNED survival for all 484 patients was 77%. The presence of PNI predicted decreased bNED survival in all patients. This detrimental effect, however, was confined to patients with pretreatment PSA values < 20 ng/mL. The bNED survival rates for patients with pretreatment PSA < 20 ng/mL demonstrated a highly significant decrease if PNI was present versus when it was absent (65% vs. 88% at 3 years, 39% vs. 65% at 5 years; P = 0.0009 for overall curve comparison). For patients with pretreatment PSA < 20 ng/mL, multivariate analysis of prognostic variables demonstrated a significant association between bNED survival and PNI (P = 0.002), palpation stage (P = 0.02), and pretreatment PSA (P = 0.006). Gleason score, age, and dose were not independent predictors of bNED survival in this group of patients.
CONCLUSIONS
To the authors' knowledge, this is the first report demonstrating that PNI detected on diagnostic transrectal biopsy is a significant predictor of decreased bNED survival in patients treated with radiotherapy. The subgroup of patients affected are those with pretreatment PSA < 20 ng/mL. This result suggests that such patients may benefit from more aggressive treatment, particularly the use of larger planning target volumes or adjuvant therapies. Cancer 1997; 79:75‐80. © 1997 American Cancer Society.
The finding of perineural invasion in the diagnostic biopsy of adenocarcinoma of the prostate is associated with an increased risk of biochemical failure in patients treated with definitive radiotherapy.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/(SICI)1097-0142(19970101)79:1<75::AID-CNCR11>3.0.CO;2-3</identifier><identifier>PMID: 8988729</identifier><identifier>CODEN: CANCAR</identifier><language>eng</language><publisher>New York: John Wiley & Sons, Inc</publisher><subject>Aged ; Aged, 80 and over ; Analysis of Variance ; Biological and medical sciences ; Biomarkers, Tumor - blood ; extracapsular extension ; Humans ; Male ; Medical sciences ; Middle Aged ; Neoplasm Invasiveness ; Nephrology. Urinary tract diseases ; perineural invasion ; Peripheral Nervous System Neoplasms - secondary ; Prostate ; prostate carcinoma ; prostate specific antigen ; Prostate-Specific Antigen - blood ; Prostatic Neoplasms - blood ; Prostatic Neoplasms - pathology ; Prostatic Neoplasms - radiotherapy ; Prostatic Neoplasms - surgery ; radiation therapy ; Treatment Failure ; Tumors of the urinary system ; Urinary tract. Prostate gland</subject><ispartof>Cancer, 1997-01, Vol.79 (1), p.75-80</ispartof><rights>Copyright © 1997 American Cancer Society</rights><rights>1997 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c4761-80f2c22c3c5e1c3747e107491ff93c09d4f3f3ab180978edd034c99b517c45db3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,4024,27923,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2522868$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8988729$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bonin, Steven R.</creatorcontrib><creatorcontrib>Hanlon, Alexandra L.</creatorcontrib><creatorcontrib>Lee, W. Robert</creatorcontrib><creatorcontrib>Movsas, Benjamin</creatorcontrib><creatorcontrib>Al‐Saleem, T. I.</creatorcontrib><creatorcontrib>Hanks, Gerald E.</creatorcontrib><title>Evidence of increased failure in the treatment of prostate carcinoma patients who have perineural invasion treated with three‐dimensional conformal radiation therapy</title><title>Cancer</title><addtitle>Cancer</addtitle><description>BACKGROUND
The detection of perineural invasion (PNI) in the diagnostic transrectal biopsy of the prostate is associated with a 93% frequency of extracapsular disease extension in patients treated by prostatectomy for adenocarcinoma of the prostate. Extracapsular extension is associated with an inferior outcome compared with that of patients who have organ‐confined disease. This study examined the association of PNI and treatment failure in a consecutive series of patients treated with three‐dimensional conformal radiation therapy (3DCRT) alone.
METHODS
The authors report actuarial biochemical no evidence of disease (bNED) survival rates for 484 consecutive patients with clinically localized prostate carcinoma diagnosed by transrectal needle biopsy who completed 3DCRT alone between May 1989 and December 1994. The median follow‐up time was 28 months (range, 2‐75 months), and the median dose to the center of the prostate was 7368 centigray (cGy) (range, 6316‐8074 cGy). Patients were subdivided into 2 groups according to pretreatment prostate specific antigen (PSA) levels (<20 ng/mL vs. ≥20 ng/mL). Pathology records were reviewed for the presence or absence of PNI. bNED failure was defined as a PSA level ≥ 1.5 ng/mL and rising on 2 consecutive occasions. bNED survival rates were calculated using Kaplan‐Meier methodology and comparisons of survival curves were accomplished using the log rank test.
RESULTS
The 3‐year bNED survival for all 484 patients was 77%. The presence of PNI predicted decreased bNED survival in all patients. This detrimental effect, however, was confined to patients with pretreatment PSA values < 20 ng/mL. The bNED survival rates for patients with pretreatment PSA < 20 ng/mL demonstrated a highly significant decrease if PNI was present versus when it was absent (65% vs. 88% at 3 years, 39% vs. 65% at 5 years; P = 0.0009 for overall curve comparison). For patients with pretreatment PSA < 20 ng/mL, multivariate analysis of prognostic variables demonstrated a significant association between bNED survival and PNI (P = 0.002), palpation stage (P = 0.02), and pretreatment PSA (P = 0.006). Gleason score, age, and dose were not independent predictors of bNED survival in this group of patients.
CONCLUSIONS
To the authors' knowledge, this is the first report demonstrating that PNI detected on diagnostic transrectal biopsy is a significant predictor of decreased bNED survival in patients treated with radiotherapy. The subgroup of patients affected are those with pretreatment PSA < 20 ng/mL. This result suggests that such patients may benefit from more aggressive treatment, particularly the use of larger planning target volumes or adjuvant therapies. Cancer 1997; 79:75‐80. © 1997 American Cancer Society.
The finding of perineural invasion in the diagnostic biopsy of adenocarcinoma of the prostate is associated with an increased risk of biochemical failure in patients treated with definitive radiotherapy.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis of Variance</subject><subject>Biological and medical sciences</subject><subject>Biomarkers, Tumor - blood</subject><subject>extracapsular extension</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neoplasm Invasiveness</subject><subject>Nephrology. Urinary tract diseases</subject><subject>perineural invasion</subject><subject>Peripheral Nervous System Neoplasms - secondary</subject><subject>Prostate</subject><subject>prostate carcinoma</subject><subject>prostate specific antigen</subject><subject>Prostate-Specific Antigen - blood</subject><subject>Prostatic Neoplasms - blood</subject><subject>Prostatic Neoplasms - pathology</subject><subject>Prostatic Neoplasms - radiotherapy</subject><subject>Prostatic Neoplasms - surgery</subject><subject>radiation therapy</subject><subject>Treatment Failure</subject><subject>Tumors of the urinary system</subject><subject>Urinary tract. Prostate gland</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><recordid>eNqFkduO0zAQhiMEWsrCIyDlAqHdixQfknXcRaBVWKDSikocBFxZrjNWjXIodtKqdzwCb8F78SRMSOgNSMiSDzO_P4_nj6LnlMwpIezJ2btlsTynRIqE0JSdUSkFoYSeC7mgT0W2WFwtXyTFm-Itpc_4nMyL1SVL-K1odrxzO5oRQvIkS_mnu9G9EL7gUbCMn0QnucxzweQs-nG9cyU0BuLWxq4xHnSAMrbaVb0HjMTdBuIOw10NTTeotr4Nne4gNtob17S1jre6c5gN8X7Txhu9g3gL3jXQe10hY6eDa5uRgvC96zaI9QA_v30vHXKHNCpN29jW17jzunTIbH8_7_X2cD-6Y3UV4MG0nkYfXl6_L14nN6tXy-LqJjGpuKBJTiwzjBluMqCGi1QAJSKV1FrJDZFlarnlek1z7FIOZUl4aqRcZ1SYNCvX_DR6PHLxl197CJ2qXTBQVbqBtg9K5DjSlKLw4yg02I7gwaqtd7X2B0WJGixUarBQDXaowQ71x0IlpMIpUwotVKOFiiuiipViiiP54VRCv66hPHInzzD_aMrrYHRlvW6MC0cZyxjLL3KUfR5le1fB4a_q_lfcP2ubIvwXfp7JvA</recordid><startdate>19970101</startdate><enddate>19970101</enddate><creator>Bonin, Steven R.</creator><creator>Hanlon, Alexandra L.</creator><creator>Lee, W. Robert</creator><creator>Movsas, Benjamin</creator><creator>Al‐Saleem, T. I.</creator><creator>Hanks, Gerald E.</creator><general>John Wiley & Sons, Inc</general><general>Wiley-Liss</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19970101</creationdate><title>Evidence of increased failure in the treatment of prostate carcinoma patients who have perineural invasion treated with three‐dimensional conformal radiation therapy</title><author>Bonin, Steven R. ; Hanlon, Alexandra L. ; Lee, W. Robert ; Movsas, Benjamin ; Al‐Saleem, T. I. ; Hanks, Gerald E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4761-80f2c22c3c5e1c3747e107491ff93c09d4f3f3ab180978edd034c99b517c45db3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis of Variance</topic><topic>Biological and medical sciences</topic><topic>Biomarkers, Tumor - blood</topic><topic>extracapsular extension</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neoplasm Invasiveness</topic><topic>Nephrology. Urinary tract diseases</topic><topic>perineural invasion</topic><topic>Peripheral Nervous System Neoplasms - secondary</topic><topic>Prostate</topic><topic>prostate carcinoma</topic><topic>prostate specific antigen</topic><topic>Prostate-Specific Antigen - blood</topic><topic>Prostatic Neoplasms - blood</topic><topic>Prostatic Neoplasms - pathology</topic><topic>Prostatic Neoplasms - radiotherapy</topic><topic>Prostatic Neoplasms - surgery</topic><topic>radiation therapy</topic><topic>Treatment Failure</topic><topic>Tumors of the urinary system</topic><topic>Urinary tract. Prostate gland</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bonin, Steven R.</creatorcontrib><creatorcontrib>Hanlon, Alexandra L.</creatorcontrib><creatorcontrib>Lee, W. Robert</creatorcontrib><creatorcontrib>Movsas, Benjamin</creatorcontrib><creatorcontrib>Al‐Saleem, T. I.</creatorcontrib><creatorcontrib>Hanks, Gerald E.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bonin, Steven R.</au><au>Hanlon, Alexandra L.</au><au>Lee, W. Robert</au><au>Movsas, Benjamin</au><au>Al‐Saleem, T. I.</au><au>Hanks, Gerald E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evidence of increased failure in the treatment of prostate carcinoma patients who have perineural invasion treated with three‐dimensional conformal radiation therapy</atitle><jtitle>Cancer</jtitle><addtitle>Cancer</addtitle><date>1997-01-01</date><risdate>1997</risdate><volume>79</volume><issue>1</issue><spage>75</spage><epage>80</epage><pages>75-80</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><coden>CANCAR</coden><abstract>BACKGROUND
The detection of perineural invasion (PNI) in the diagnostic transrectal biopsy of the prostate is associated with a 93% frequency of extracapsular disease extension in patients treated by prostatectomy for adenocarcinoma of the prostate. Extracapsular extension is associated with an inferior outcome compared with that of patients who have organ‐confined disease. This study examined the association of PNI and treatment failure in a consecutive series of patients treated with three‐dimensional conformal radiation therapy (3DCRT) alone.
METHODS
The authors report actuarial biochemical no evidence of disease (bNED) survival rates for 484 consecutive patients with clinically localized prostate carcinoma diagnosed by transrectal needle biopsy who completed 3DCRT alone between May 1989 and December 1994. The median follow‐up time was 28 months (range, 2‐75 months), and the median dose to the center of the prostate was 7368 centigray (cGy) (range, 6316‐8074 cGy). Patients were subdivided into 2 groups according to pretreatment prostate specific antigen (PSA) levels (<20 ng/mL vs. ≥20 ng/mL). Pathology records were reviewed for the presence or absence of PNI. bNED failure was defined as a PSA level ≥ 1.5 ng/mL and rising on 2 consecutive occasions. bNED survival rates were calculated using Kaplan‐Meier methodology and comparisons of survival curves were accomplished using the log rank test.
RESULTS
The 3‐year bNED survival for all 484 patients was 77%. The presence of PNI predicted decreased bNED survival in all patients. This detrimental effect, however, was confined to patients with pretreatment PSA values < 20 ng/mL. The bNED survival rates for patients with pretreatment PSA < 20 ng/mL demonstrated a highly significant decrease if PNI was present versus when it was absent (65% vs. 88% at 3 years, 39% vs. 65% at 5 years; P = 0.0009 for overall curve comparison). For patients with pretreatment PSA < 20 ng/mL, multivariate analysis of prognostic variables demonstrated a significant association between bNED survival and PNI (P = 0.002), palpation stage (P = 0.02), and pretreatment PSA (P = 0.006). Gleason score, age, and dose were not independent predictors of bNED survival in this group of patients.
CONCLUSIONS
To the authors' knowledge, this is the first report demonstrating that PNI detected on diagnostic transrectal biopsy is a significant predictor of decreased bNED survival in patients treated with radiotherapy. The subgroup of patients affected are those with pretreatment PSA < 20 ng/mL. This result suggests that such patients may benefit from more aggressive treatment, particularly the use of larger planning target volumes or adjuvant therapies. Cancer 1997; 79:75‐80. © 1997 American Cancer Society.
The finding of perineural invasion in the diagnostic biopsy of adenocarcinoma of the prostate is associated with an increased risk of biochemical failure in patients treated with definitive radiotherapy.</abstract><cop>New York</cop><pub>John Wiley & Sons, Inc</pub><pmid>8988729</pmid><doi>10.1002/(SICI)1097-0142(19970101)79:1<75::AID-CNCR11>3.0.CO;2-3</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Analysis of Variance Biological and medical sciences Biomarkers, Tumor - blood extracapsular extension Humans Male Medical sciences Middle Aged Neoplasm Invasiveness Nephrology. Urinary tract diseases perineural invasion Peripheral Nervous System Neoplasms - secondary Prostate prostate carcinoma prostate specific antigen Prostate-Specific Antigen - blood Prostatic Neoplasms - blood Prostatic Neoplasms - pathology Prostatic Neoplasms - radiotherapy Prostatic Neoplasms - surgery radiation therapy Treatment Failure Tumors of the urinary system Urinary tract. Prostate gland |
| title | Evidence of increased failure in the treatment of prostate carcinoma patients who have perineural invasion treated with three‐dimensional conformal radiation therapy |
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