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This may be due to the association of PNI with more diffuse disease, leading to increased biopsy tumor yield and grading accuracy. These findings suggest that in this setting, biopsy PNI alone should not be a concern for more aggressive disease requiring pathologic confirmation or intervention. This may help guide treatment decision-making for men debating active surveillance, radiation, and surgery. © 2020 The Authors. Cancer Medicine published by John Wiley Sons Ltd.Though tetrapyrazinoporphyrazines (TPyzPzs) are generally present