Perineural invasion question

I have a question for anyone who knows anything about perineural invasion on biopsy..

My dad was found to have perineural invasion on biopsy. His surgery is coming up and I am getting worried about the post-op path report. Has anyone had a perineural invasion on biopsy and turned out to have negative margins?

Any information on this would be greatly appreciated. Thank you.

LuvMyDAD

Most perineural invasions are microscopic, that is less than 1/10 mm. So I wouldn't get excited until the path report after the surgery

Perineural invasion is very common and isn't necessarily associated with positive surgical margins. Many a post surgery pathology says there is perineural invasion but also says negative surgical margins. It is usually talking about the nerve pathways contained within the prostate gland. All it means is that that particular biopsy sample hit a tumour containing nerve pathway within the gland. Take mine. Negative for perineural invasion at biopsy (obviously the needles missed the nerve pathways) but extensive perineural involvement revealed at post surgery pathology with negative surgical margins. I wouldn't be particularly concerned about it at this stage.
Bill

From the charts I've read PNI is not used to predict long-term outcomes. They found it in me and I had negative margins.

I was told nothing to worry about, move along in my life.

OBB

I will present the opposite view of PNI from my own case. It showed up in my biopsies (3), and showed up again in my post surgery pathology report. My surgeon said it could mean something later on, but not to worry about it.

In my case, dealing with some steep PSA velocity in the year or two before surgery (Background note)

Within 9 months of surgery, had confirmed reoccurance. Just completed IMRT for salvage. (39 sessions)

I met with 3 different radiation oncologists before choosing the one that I went with. All 3 of them, put a lot of stock in the importance of PNI. They strongly believe that it can be an easy gateway for PC cells to escape. And in cases of high psa velocity they felt it was the likely reason there was such early reoccurance. My very case may be proof of their theory on PNI.

It was part of the formula why I was given so much radiation on the salvage.

Should you worry about that now? No. But keep it in the back of your mind. Shows that a good radiation oncologist and a good surgeon can have two different views about the same thing.

David in SC

First, ask away, from all of of us. There is no such thing as too many questions here, no such thing as a dumb question. I can't take credit for this quote, I picked it up here, but the best way to overcome fear with PC, is with knowledge.

Second, I am not a dr nor have any qualifications, I am answering based on how my team of doctors answered me in my case.

Thirdly, a positive margin does not mean you will have reoccurance, but it can. And we have men without positive margins, that do have reoccurance. That is the annoying thing about PC, it doesn't follow the rules of fairness or consistency.

Fourth, you asked if you have a psa reoccurance after surgery, does that mean chances of cure are gone. No way to know or answer that precisely. The great unknown in that situation is the reoccurance local, i.e. to the prostate bed or general region, or has it metasizied elsewhere in the body, or also, it can be both at the same time.

With our present technology and testing, and please someone step in if I am wrong on this point, there is no accurate fool proof way to know the difference.

With some men, let's say they have surgery, and it fails like mine did, and then they have radiation, and for all reasonable purposes, they are "cured". With other men, even the radiation can fail. If the radiation fails as a salvage, then the PC is said to be no longer curative.

Its not like I am beating around the bush, or other posters here, but PC again, has its own rhyme and reason. If we only knew from the start whether our cancer was indolent (not likely to ever turn agressive in our lifetime), or agressive, and just waiting to get you, we would be so much better off after we get our diagnosis. We have men that have surgeries that are never needed, and men that have surgeries that are destined to fail, and men that have surgeries that work. And not just surgeries, but whatever primary treatment they choose would have the same choices of outcomes.

I am glad your dad has you. Can't remember seeing your name, so not sure if you are a son or daughter, but I am so glad that my adult age children live close to me, and all take an active role in keeping a close eye on the old man. Bless you for that.

David in SC

Your dad is lucky to have a caring daughter like you. Even at age 28 and married, my daughter is still a daddy's girl. Yes, wait patiently for that full pathology report and try not to read too much into it. For many men with low grade prostate cancer , the cure rate is still real high. And even for the me with more agressive cancers or advance cases, still lots of avenues of hope.

I think you are doing fine.

David in SC

Rolerbe:  So wonderfully stated. Kind of made me teary eyed for I too have made that cavalier statement which begins “well at least its only”…dang I still feel like a fool. We use Lean and Six-sigma in health care all the time; but when you become a member of the “Ca” group in the fraction Ca/P things change….

Hero

Luv, your statement that other cancers can be cured at the 5 year mark but prostate cancer is one that haunts you forever is not completely accurate. Any person who has been treated for cancer - any cancer - can have a recurrence. The recurrence can happen almost immediately after treatment, a year later, 5 years later, or even 15-20 years later. All cancers require diligence for the person's lifetime. I think the difference with prostate cancer is that no chemotherapy has been established to fight the disease from the beginning. We rely on surgery or radiation as the primary first-line treatments, and these are both local treatments rather than systemic like chemotherapy. If there's a recurrence, right now there doesn't appear to be a test that can determine if it's local or systemic. With most other cancers, you can do PET scans to see how far the cancer has progressed and where it has spread. I don't believe that prostate cancer is more difficult to treatment; I think it just plays by different rules than other cancers.