Perineural invasion (PNI) in prostate biopsy specimens is a strong predictor of prostate cancer (PCa) bone metastasis, new findings suggest.

In a retrospective study of 633 PCa patients, investigators found that PNI was associated with an 11-fold increased risk of bone metastasis among patients for whom a bone scan is indicated on the basis of National Comprehensive Cancer Network (NCCN) criteria, according to a paper published online ahead of print in The Prostate.

The researchers divided patients into group 1 and group 2. Group 2 included 371 patients with any of the following: symptomatic disease, Gleason sum of 8 or higher, clinical stage T3 or T4, clinical stage T1 with a total PSA level greater than 20 ng/mL, or clinical stage T2 with total PSA greater than 10 ng/mL. The remaining 262 patients were placed in group 1.

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Results revealed no significant association between PNI and bone metastasis in group 1, but a strong association between PNI and bone metastasis in group 2. PNI had a sensitivity and specificity for bone metastasis of 72.4% and 81.7%, respectively, and a positive predictive value of 77.7%, Seyfettin Ciftci, MD, of Sivas Numune State Hospital in Sivas, Turkey, and colleagues reported.

“We recommend that PNI should be kept in mind as an adverse parameter for the appropriate evaluation of bone metastasis,” Dr. Ciftci’s group concluded.