Two new predictors of cancer recurrence after surgery: Perineural invasion and lymphovascular invasion

This study examined two new predictors of prostate cancer recurrence – perineural invasion (PNI) and lymphovascular invasion (LVI). Researchers reported increased recurrence risk after prostate surgery if patients show PNI or LVI before surgery, particularly if both were present. 

Localized (confined) prostate cancer is commonly treated with surgery or radiation. Some men are at increased risk of cancer recurrence after treatment. Markers in the blood and prostate tissue samples are often used to grade the aggressiveness of cancer and determine recurrence risk.

Perineural invasion (PNI) and lymphovascular invasion (LVI) have recently emerged as possible new predictors of prostate cancer recurrence. PNI refers to the presence of cancer cells near or along a nerve fiber within the prostate. LVI refers to the presence of cancer in local blood vessels or lymphatics (vessels part of the circulatory system involved in immune response). Previous reports are suggesting that when PNI or LVI is found, the chance of cancer spread and recurrence is increased. However, evidence to this effect is still inconclusive. Predicting the risk of recurrence can help in appropriate treatment selection.

The aim of this study was to determine whether PNI or LVI can predict recurrence risk after surgery.

2,034 men with localized prostate cancer were included in this study. The men were examined for the presence of PNI, LVI, and other standard cancer markers. All men were then treated with prostate surgery. Recurrence rates were recorded over an average period of 48 months.

PNI was detected in 69.3% of men and LVI was detected in 12.4% of men. Patients with PNI or LVI were more likely to have advanced disease. Higher tumor stage, increased cancer markers in the blood and in tissue samples, tumor protruding into nearby tissue, and cancer spread to semen glands were all more likely among men who showed PNI or LVI.

14.7% of men showed disease recurrence (based on blood tests) during the study period. PNI and LVI both independently predicted recurrence after adjusting for standard cancer markers. The risk of recurrence was increased 2.11-fold if PNI was present and increased by 57% if LVI was present. The presence of both PNI and LVI increased recurrence risk 4.6-fold.

Researchers concluded that PNI and LVI are independent predictors of cancer recurrence after surgery. The risk of recurrence is even higher if both are present.