Hi ARangel14,
I had three pathologist reports from my original (mid-summer 2014) prostate biopsy. The first said Gleason 6 (3+3) in 4 cores. with Gleason 7 (3+4) in two cores. I got a second opinion. The second opinion said, based on the same set of slides, I had Gleason 6 (3+3) in 6 cores. Thirteen other cores were benign/negative. To resolve the difference of opinion I got a third opinion (or a second Second Opinion), from Epstein at Johns Hopkins. Epstein confirmed the Gleason 6s all around (six 3+3s) but added a notation to his pathology report, "Perineural Invasion identified in this case." Perineural Invasion is long for PNI.
A CT scan two weeks later showed my cancer seemed to be contained with my prostate capsule. As Epstein didn't explain what PNI was, and I was between appointments with my urologist, I did some research on my own. Here is what the website
www.advancedprostatecancer.net/?p=3750 had to say about
PNI. Please be aware I've no idea who wrote the following. What their medical training is. A nurse, a PhD researcher, who knows? The website doesn't say who wrote it. (Insofar as I recall.)
"When a pathologist finds that there is PNI [perineural invasion] they are saying that they have found prostate cancer cells surrounding or tracking along a nerve fiber within the prostate. This does not mean that the cancer has left the gland."
It goes on to say, "Notwithstanding the importance of this finding, it takes on a new light when you realize that nerves within the prostate travel outside of the prostate gland through microscopic holes in the prostate capsule. The capsule is the outer covering of the prostate gland, which for some period of time can manage to contain cancer cells within the gland. In essence it is a barrier protecting the rest of your body from prostate cancer cells."
"However, the nerves do pierce the capsule and can offer an easy exit point for cancer cells from the gland to the rest of your body."
"The real concern about
the presence of PNI in a biopsy is it indicates there is a higher likelihood that the prostate cancer
has or will [emphasis added by me] escape from the prostate gland, or become advanced prostate cancer."
"Simply put, the presence of PNI doubles the chance of a man having T3 disease (tumors that have broken through the capsule)."
It gets even more depressing as you continue reading. I'll stop quoting from the website I mention above now. Go there to read more.
Since I first read what I quote above, I initially totally freaked out, went from celebrating my Gleason 6s all around Epstein decreed, case closed, to being way down in the dumps about
PNI. If Epstein found cancer cells surrounding or tracking a nerve inside my prostate, he didn't explicitly say so.
[Rather, Epstein didn't say he found cancer cells surrounding or tracking a nerve inside my prostate -- he only said, "Perineural Invasion identified in this case."]. Which has had me sweating ever since I read what the
www.advancedprostatecancer.net/?p=3750 website said about
PNI.
Other members here on the Prostate Cancer Forum have given me some encouragement about
not dwelling on my PNI. Yes, it increases my risk factor some small percentage ... I dunno, 5% maybe [that's a guess, I said that, based on nothing ... I don't recall if anyone quantified the risk} appropos the risk of my prostate cancer escaping the prostate capsule.
I hope this post cheers you rather than depresses you. If you know me from the thread I started on the Forum about
"Is Active Surveillance rolling the dice? From Gleason 6-7 to Gleason 6, and my psa going down" you'll know that I accept as real and true that what I think creates my reality. Honestly.
I'm saying that if I'm going to worry all the time about
whether my PC is leaking out of my prostate through microscopic holes in my prostate capsule, where tiny tiny nerves go through those holes, then [according to quantum physics explanation about
how reality works] I'm actually encouraging Existence to do exactly that, because in part I'm putting so much energy into worrying about
that.
If on the other hand, I don't worry about
it, yes, it's a small added risk, no I'm not obsessed with it, then I sincerely believe Existence is going to mirror that reality back to me . . . it's a small risk, not worth dwelling on. I've gone from despair over having PNI to I don't worry about
it hardly at all. Are my cancer cells getting the message from Existence [which includes me, and some would say, IS ME]? I certainly hope so!!
Hope this helps!
Bill
______________________________________________
70 years in this body I've only just recently
properly appreciated -- better late than never!
Prostate biopsy procedure late July 2014
Diagnosed Prostate Cancer early August 2014
Prostate nodule 7/2014, 6 /2014, 4/2014
PSA history:
1/08 4.6
4/08 6.4
7/08 3.5
12/09 2.5
2/11 4.4
4/12 3.2
4/14 5.4
8/14 5.1
9/3/14 4.9
CT & bone scan 8/12/2014 negative
1st Pathology Report (8/1/2014) on 7/28/14 biopsy
4 cores Gleason 6 (3+3), 69%, 75%, 100%, 100%
2 cores Gleason 7 (3+4), 66%, 88%
1st Second Opinion Pathology Report (8/26/2014) on 7/28/14 biopsy
6 cores Gleason 6 (3+3), 77%, 77%, 78%, 78%, 95%, 95%
2nd Second Opinion (or 3rd overall) Pathology Report (9/12/2014, Johns Hopkins) on 7/28/2014 biopsy.
6 cores Gleason 6 (3+3),
A. prostatic adenocarcinoma, 90%, 80%
B. prostatic adenocarcinoma, 90%, 90% ("perineural invasion identified in this case")
C. prostatic adenocarcinoma, 90%, 90%