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However, its role in metastatic PCa (mPC<\/jats:styled-content>a) remains unknown.<\/jats:p><\/jats:sec>Objectives<\/jats:title>We aim to investigate the clinical significance of PNI<\/jats:styled-content> in patients with mPC<\/jats:styled-content>a.<\/jats:p><\/jats:sec>Materials and methods<\/jats:title>Data of 515 mPC<\/jats:styled-content>a patients between 2012 and 2018 were retrospectively studied. PNI<\/jats:styled-content> and its intensity were identified by prostate biopsy. The prognostic value of PNI<\/jats:styled-content> was evaluated by Kaplan\u2013Meier curves and Cox proportional\u2010hazards model.<\/jats:p><\/jats:sec>Results<\/jats:title>Perineural invasion was detected in 170\/515 (33.0%) cases. Among them 73\/170 (42.9%) and 97\/170 (57.1%) harbored unifocal PNI<\/jats:styled-content> (uni\u2010PNI<\/jats:styled-content>) and multifocal PNI<\/jats:styled-content> (multi\u2010PNI<\/jats:styled-content>), respectively. Compared to patients without PNI<\/jats:styled-content>, those with PNI<\/jats:styled-content> had statistically shorter castration\u2010resistant PCa\u2010free survival (CFS<\/jats:styled-content>) and numerically shorter overall survival (OS<\/jats:styled-content>) (mCFS<\/jats:styled-content>: 15.4\u2010 vs. 18.5\u2010Mo, p<\/jats:italic>\u00a0=\u00a00.015; mOS<\/jats:styled-content>: 63.8\u2010 vs. 71.4\u2010Mo, p<\/jats:italic>\u00a0=\u00a00.108). Patients harboring multi\u2010PNI<\/jats:styled-content> were associated with poorer clinical outcomes than those with uni\u2010PNI<\/jats:styled-content> (mCFS<\/jats:styled-content>: 12.4\u2010 vs. 18.0\u2010Mo, p\u00a0<\/jats:italic>=\u00a0<\/jats:italic>0.040; mOS<\/jats:styled-content>: 39.7\u2010Mo vs. NR<\/jats:styled-content>, p\u00a0<\/jats:italic>=\u00a0<\/jats:italic>0.018) or those without PNI<\/jats:styled-content> (mCFS<\/jats:styled-content>: 12.4\u2010 vs. 18.5\u2010Mo, p\u00a0<\/jats:italic>=\u00a0<\/jats:italic>0.002; mOS<\/jats:styled-content>: 39.7\u2010 vs. 71.4\u2010Mo, p\u00a0<\/jats:italic>=\u00a0<\/jats:italic>0.002). Totally, neither uni\u2010PNI<\/jats:styled-content> nor multi\u2010PNI<\/jats:styled-content> was an independent risk factor impacting survival outcomes in multivariate analyses. While remarkably, for patients with favorable\/intermediate\u2010risk mPC<\/jats:styled-content>a, multi\u2010PNI<\/jats:styled-content> was an independent adverse prognosticator for both CFS<\/jats:styled-content> and OS<\/jats:styled-content> (CFS<\/jats:styled-content>: HR<\/jats:styled-content>: 1.705, 95% CI<\/jats:styled-content>: 1.029\u20132.825, p\u00a0<\/jats:italic>=\u00a0<\/jats:italic>0.038; OS<\/jats:styled-content>: HR<\/jats:styled-content>: 3.294, 95% CI<\/jats:styled-content>: 1.464\u20137.413, p\u00a0<\/jats:italic>=\u00a0<\/jats:italic>0.004).<\/jats:p><\/jats:sec>Discussion and Conclusion<\/jats:title>This study filled the blank of the clinical significance of PNI<\/jats:styled-content> in mPC<\/jats:styled-content>a. We found that multi\u2010PNI<\/jats:styled-content> could distinguish men with relatively poor prognosis from patients initially regarded as with favorable survival outcomes by other prognosticators, and thus, avoid disease underestimation in this group of patients. Our finding would help physicians have a deeper understanding of the heterogeneity of mPC<\/jats:styled-content>a and make better individualized therapeutic strategy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/andr.12578","type":"journal-article","created":{"date-parts":[[2019,1,4]],"date-time":"2019-01-04T19:07:52Z","timestamp":1546628872000},"page":"184-192","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["The clinical significance of perineural invasion in patients with de novo metastatic prostate cancer"],"prefix":"10.1111","volume":"7","author":[{"given":"J.","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Urology Institute of Urology, West China Hospital, Sichuan University Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Urology Institute of Urology, West China Hospital, Sichuan University Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pathology West China Hospital, Sichuan University Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"X.","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Oncology West China Hospital, Sichuan University Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Urology Institute of Urology, West China Hospital, Sichuan University Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Urology Institute of Urology, West China Hospital, Sichuan University Chengdu 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