Quantification of perineural invasion on prostate biopsy improves risk stratification in biopsy Grade Group 2–3 cancer

Objective: Perineural invasion (PNI) detected on prostate needle biopsy is a well-established indicator of adverse pathology, while the prognostic role of PNI quantification has recently been suggested. We herein aimed to determine whether PNI quantification could universally stratify risks by separately assessing subgroups of patients based on biopsy Grade Group (GG). Methods: We quantified actual PNI foci in the entire systematic sextant biopsy specimens from 840 men, including 580 (69.0%) exhibiting no PNI and evaluated long-term oncologic outcomes following radical prostatectomy. Results: = 0.021) groups. Meanwhile, PNI on prostatectomy was confirmed in 98.1% of biopsy PNI-positive cases but was still detected in 72.2% of biopsy PNI-negative cases. Conclusion: Quantification of actual PNI foci across all systematic biopsy sites may provide valuable prognostic information, particularly in patients with GG2-3 cancer. Notably, the mere presence of biopsy PNI may not universally predict poorer outcomes.