The Impact of Perineural Invasion on Prognosis in Patients Undergoing Robot-Assisted Radical Prostatectomy

Abstract

Objective: This study aimed to investigate the clinical relevance of perineural invasion (PNI) detected in prostate needle biopsy specimens (PNIb) and radical prostatectomy specimens (PNIp) and to evaluate its associations with clinical characteristics, histopathological features, biochemical recurrence, and prognostic outcomes in patients undergoing nerve-sparing robot-assisted radical prostatectomy (RARP).

Methods: A retrospective analysis was conducted on 106 patients who underwent RARP for prostate cancer between September 2016 and December 2021 at the institution. Clinical data, including prostate-specific antigen (PSA) levels, multiparametric magnetic resonance imaging findings, biopsy results, and postoperative pathology reports, were reviewed. Patients were stratified based on the presence of PNI in prostatectomy specimens (PNIp), and oncological outcomes were compared accordingly.

Results: The presence of PNIp was significantly associated with higher PSA density (P = .031), a greater frequency of PIRADS ≥3 lesions (P = .048), and a higher percentage of tumor involvement in biopsy cores (P = .001). Gleason scores ≥7 (P = .028) and positive surgical margins (P = .009) were also more prevalent in the PNIp group. Although biochemical recurrence occurred more frequently in PNIp-positive patients (21.1%) compared to PNIp-negative patients (6.7%), this difference did not reach statistical significance (P = .076). The mean time to biochemical recurrence was shorter in the PNIp-positive group (69.6 months) compared to the PNIp-negative group (78.6 months). Multivariate logistic regression analysis did not identify any independent predictor of recurrence (Nagelkerke R2 = 0.155, P < .001).

Conclusion: While PNIp was significantly associated with adverse pathological features, it did not independently predict biochemical recurrence. Nevertheless, the earlier onset of recurrence in PNIp-positive patients—despite the lack of statistical significance—may suggest potential clinical relevance that warrants further investigation.

Cite this article as: Rzayev V, Bedir S, İlki FY, Bedir S, Topçu YK, Ebiloğlu T, Coğuplugil AE. The impact of perineural invasion on prognosis in patients undergoing robot-assisted radical prostatectomy. Cerrahpaşa Med J 2025, 49, 0026, doi:10.5152/ cjm.2025.25026.