Biopsy Results - PNI for one core

My doc gave me results by phone but I just got a look at the actual report and his summary.

I didn't know I was supposed to be worried about "perineural invasion"! I asked the doc on the phone if there was anything to suggest it had or hadn't spread outside the prostate, and all he said was it was statistically unlikely. Does a 100% core and PNI mean it is likely or has already happened?

Here's my best re-typing of the results. Spell-check is useless, of course.

He says the cancer is "early stage (clinical stage T1c), moderate grade (Gleason score equals 7), adenocarcinoma of the prostate with a PSA of 5.2. Taken together, these are favorable prognostic indicators."

Okay, I like the favorable part.

Here's what came from the cores:
R med apex Vol 5% - G1 3/50 - G2 3/50 - Gleason 6 - no PNI
L lat apex 1/1 Vol 100% - G1 3/80 - G2 4/20 - Gleason 7 - PNI seen (??)
L med apex - Vol 30% - G1 3/80 - G2 4/20 - Gleason 7 - no PNI
L ant - Vol 30% - G1 3/80 - G2 4/20 - Gleason 7 - no PNI
L lat base - Vol 5% - G1 3/50 - G2 3/50 - no PNI

Microscopic Diagnosis:
2, 7-9, 11. Prostatic adenocarcinoma, Gleason score 3+4=7. Focal perineural invasion identified.
1 - right lateral apex - Focal high-grade prostatic intraepithelial neoplasia (HGPIN)
3-6, 10, 12 Benign prostatic tissue.

So here's the question I've been asking for the past two months and with every bit of news: Should I be freaked out?

I have a meeting with Dr. Stricker on Monday (Jan 31). I'll be taking these results, of course, along with the actual slides. I can't wait to hear his opinion.

MoreData, Dr Philip Sticker was also my surgeon, and I had a similar path report to yours, actually mine looks slightly worse, higher gleason and PNI. I am now 2 years down the track and doing great. I am very pleased I chose Dr Sticker, as he was highly recommended to me at the time. There are several members here on this forum, under Dr Sticker, and I believe all doing well. Just relax and stay positive.....................Cheers Kev.

While most surgeon's opinion downplay PNI significence, I talked to 2 medical oncologist and 3 radiation oncologists and all of them shared the same view on PNI, as being potentially dangerous, and it can allow easy escape for cancer cells. As they told me, it can explain men with quick BCR after surgery that seemed to have pretty clean pathology reports. It can explain how micro-metstasis can happen quickly.

David in SC

Nothard,

Moredata is from Michigan not from Australia so he must be referring to a different Dr Stricker to the one we went to.

Moredata,

The news is mostly good in this report, I think. 

There are two areas of concern for me in this report. One is that one core has 100% of cancer potentially indicating involvement of margins (as Fairwind says above) or at least a concentration of cancer in that area. The other aspect is that a lot of the cancer is in the Apex - this is an area that frequently has positive margins as surgeons restore the urethra after removing the prostate. If your cancer was mostly in the transitional zone, surgery would have been a great option as the cancer would be away from the margins. In the case ofthe cancer being concentrated at the apex - an area prone to positive margins anyway I think looking at Brachytherepy would be a good idea.

An

An38 and Fairwind bring up a question for me.  When a core is taken, does the sample start at the surface of the prostate, meaning that a 100% core is essentially at the surface?  I had a 90% core which I obviously knew represented a larger tumor than a 50% core, but I didn't think this related to closeness to the surface.

An and Fairwind bring up good points on the 100% core. There have been a few studies on PNI and all have shown no statistical difference in reoccurrances on having PNI on either a biopsy or on final pathology.
The key to a successful surgery is knowing before you go in the precise location of the tumor as this is the largest reason for positive margins.
51% of all positive margins occur in the APEX.
JT

So the call on the PNI appears to range from neutral to moderately negative. I don't completely understand how PNI can be related to aggressive tumors but not to prognosis, but that does appear to be the consensus. I like that consensus. There is still so much I don't know about PC.

That 100% core has me spooked. I wish I understood better how the cores are taken. My initial reaction was it meant the tumor went all the way to the surface but Mackattack may have a point that it's not that simple. I hope he's right.

If the tumor is outside the prostate I hope it's the less agressive 3 cells rather than the 4 cells. With 80% of the cores at 3, statistically it sounds good, but I know the 4s are the ones most likely to venture out.

Part of my problem is I got my bad news in a phone call from the doc who did the biopsy (which was good -- less than a week later) but he just told me it was cancer, G7, contained, and my prognosis was good, good luck with the next set of docs. I'm supposed to get the written report by mail. I picked it up Friday afternoon and am now left the weekend (at least) to figure out what it means. I wish I could have had a chance to ask the doc these questions.

I'll ask the two surgeons I'm meeting with this week (first is Monday the 31st) and the radiation oncologist I'm scheduled with the week following. I suppose their answers will be more important anyway.

In general, I'm exhausted from living in fear for the past two months and in terror for the last five days. I'm eager to get past whatever treatment I choose so I can go back to less-immediate fear over post-treatment PSAs. I'm supposed to be a pillar of strength and courage for my immediate and extended families but not doing so well. I'm so afraid of leaving my wife, missing the rest of my time with the kids, and the twins not even remembering me. As I keep telling people, it's not so much the odds as the stakes that have me scared.

Thanks everyone for the information.

Here's one interesting tidbit on PNI:

http://snr.spl.harvard.edu/publications/item/view/1165

More Data,
The larger the tumor the more chance of it having PNI. It's a simple mathematical relationship based on size of the tumor and size of the gland. The larger tumor will have a greater probability of PNI because nerves run throughout the gland. This does not mean anything else, and the existance of PNI doesn't mean any worse prognosis. A large tumor does directly relate to a worse prognosis.
JT

(Revised) to reflect more serenity in dealing with it all.

Best to you in whatever your decisions become. It is never an easy road.

Post Edited (zufus) : 1/30/2011 9:27:03 AM (GMT-7)

Those sound like nice post-op numbers.  I think you can relax and celebrate President's Day in whatever manner you choose.