Adenocarcinoma of the Prostate
This slide is from an elderly male with prostate cancer. He is thought to have a poor prognosis because of one feature in this slide (see arrow).
What is that feature?
- Gleason grade 1+3
- Papillary carcinoma
- Vascular invasion
- Perineural invasion
Scroll below for answer.
Comment: Perineural invasion (PNI) was thought to be an accurate indicator of invasive capability of the cancer and considered an important risk factor. Recent analyses have suggested that PNI does not correspond with metastases. However, the question is still being debated in the literature.
Egan AJ, Bostwick DG. Prediction of extraprostatic extension of prostate cancer based on needle biopsy findings: perineural invasion lacks significance on multivariate analysis. Am J Surg Pathol. 1997 Dec;21(12):1496-500. PMID: 9414194
Masieri L, Lanciotti M, Nesi G, Lanzi F, Tosi N, Minervini A, Lapini A, Carini M, Serni S. Prognostic role of perineural invasion in 239 consecutive patients with pathologically organ-confined prostate cancer. Urol Int. 2010;85(4):396-400. Epub 2010 May 28. PMID: 20516669
Harnden P, Shelley MD, Clements H, Coles B, Tyndale-Biscoe RS, Naylor B, Mason MD. The prognostic significance of perineural invasion in prostatic cancer biopsies: a systematic review. Cancer. 2007 Jan 1;109(1):13-24. PMID:17123267
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