PNI reading?

From:

www.cancer.org/treatment/understandingyourdiagnosis/understandingyourpathologyreport/prostatepathology/prostate-cancer-pathology

"Perineural invasion means that cancer cells were seen surrounding or tracking along a nerve fiber within the prostate. When this is found on a biopsy, it means that there is a higher chance that the cancer has spread outside the prostate. Still, perineural invasion doesn’t mean that the cancer has spread, and other factors, such as the Gleason score and amount of cancer in the cores are more important. In some cases, finding perineural invasion may affect treatment, so if your report mentions perineural invasion, you should discuss it with your doctor. "

its prognostic for for epe...but once post surgical pathology shows no epe...it means nothing...in other word...its there in biopsy ...so it could escape via that route...but if postop pathology shows no epe/pos margins...it is no longer prognostic for squat...some diehards{bad news to good news always dies hard...not so...good to bad}still some will say... well a cell could have been missed and its out...what will I do... what will I do...with cheese.. go figger... As some one once said here and it a great line..."worrying is like praying for something bad to happen...

My 2nd opinion biopsy reading from Johns Hopkins mentioned PNI as well.

With all of my initial numbers, and the 3TMRI indicating a bulging capsule, neurovascular bundle involvement, and "suspicious for extracapsular extension", it seemed like it was out of the capsule. The PNI indication also supported that, particularly in conjunction with the G9 5+4, pretty high involvement in 6 of 12 cores. All indicating surgery was not likely to get it all, though it was a bit arguable at the time.

In short, the presence of PNI further supported for me what the 3TMRI was suggesting. Not definitive, but it seems one needs to make a holistic assessment of all the factors when making treatment choices.

It's a relatively small risk factor. Congratulations on your "low risk" verdict. It sounds pretty similar to my diagnosis. Knowing what I know now, I'd probably have started off with active surveillance and maybe have gone a couple of more years without treatment. There will always be the next new thing.

All information is in the I of the beholder...perspective...ignore { the toot [ill keep that typo] word of ignorance}is not the answer...wingman...an I filled with sand will put one to sleep...but with no sound...and much fury...

I do appreciate the magistrate in your word's however...stimulates truth...matters not from where....

Since you can't see this, perhaps someone else can pass it along. You can unignore someone by going into My Profile>Edit Ignored Users. Fortunately, I've only felt the need to use it a couple of times on this forum.

I chose SBRT - you can see my details ind links to some good data on it in my signature below. Where I live (in LA) the pioneers of both SBRT and HDR brachytherapy are only a 10 minute drive from where I live. There are some very experienced surgeons in the area too. They didn't have the very impressive 20-year data on active surveillance at the time. Since all therapies are equally good (95+% cure rates) for low risk PC, my choice was made on the basis of preserving erectile function, which is very important to me. Both SBRT and HDR brachy have the top records on that. I could have gone with either happily. In the end, I liked the ease, convenience and cost of SBRT. That was 6 years ago - no lasting side effects of treatment whatsoever, other than loss of ejaculate fluid.

My original biopsy reports mentioned no PNI, but my post-prostatectomy pathology reported "extensive" PNI. This aroused my curiosity. I found conflicting information in the research articles. A 2015 Australian study concluded that PNI at radical prostatectomy is not an independent predictor of biochemical recurrence and questioned whether its presence should even be mentioned in pathology reports. A 2015 Chinese study concluded that PNI was associated with higher risk for biochemical recurrence after local treatment and should, therefore, be considered when assessing the risk of biochemical recurrence, thereby to achieve the best treatment.

The question in any case is "So what?" Unless the presence of PNI recommends one course of treatment over another, it doesn't contribute much to our decision-making. In my case, I didn't learn of the PNI until I had the RP, so chalk that up as one of the benefits of RP: you get a pathology report that tells you more than you would have known if you elected for radiation. In my case, I learned about tertiary 5 that was not discovered in the biopsy and also that I did not have extracapsular extension, seminal vesicle involvement, or lymph node invasion. Although the odds that the RP would cure me looked good, I have BCR 20 months after surgery and have just begun salvage radiotherapy. Were the tertiary 5 or extensive PNI somehow connected with my relatively early failure? My surgeon said nothing about such a risk when we talked about the pathology report and for 10 months I celebrated my undetectable PSA status.

Now, as to choices, I chose RP for a variety of reasons, although I think the HDR brachytherapy + EBRT + ADT offered by a radiation oncologist at a leading prostate cancer center may have had a better outcome. Whatever treatment you have, you are only playing percentages. I had nerves spared on both sides by one of the most highly regarded surgeons in the country but I have not recovered erectile function even with pills although bimix works. Was fine before surgery. With RP, my predicted chance of BCR within 5 years of surgery was low and I was very attracted to the idea of string of "zero" PSA readings starting with my first test after surgery. But here I am, hoping salvage radiotherapy will salvage me a cure.

Although initial treatment with SBRT or HDR brachy or the combination of radiation and androgen-deprivation therapies that was proposed to me may have a better likelihood of preserving erectile function, no therapy that cures prostate cancer is without the possibility of serious lasting side effects.

With Grade 1 (Gleason 3+3), you fall into the category of newly diagnosed men who have been overtreated as a whole. You should learn as much about active surveillance as you can to see if you can get comfortable with the idea of leaving your 3+3 untreated for now. It is possible that it will NEVER graduate to a higher level.

As the old saw goes, "You pays your money and you takes your choice." If I had qualified for active surveillance at a major prostate cancer research hospital, I would have chosen that in a heartbeat.

dm, the good news is that JH confirmed the overall G6 reading, however you do have bilateral involvement which moves you up slightly in the risk categories. IMO, you're still a candidate for AS. Do I remember correctly that you're in the Joplin MO area? Seriously, you might call JH (especially since they have your pathology on file now), and ask about whether you'd qualify for their AS program "at a distance".

Dr Epstein is a pathologist, not a clinician. He does not treat patients, and he is certainly not an expert on available treatments. You should understand that JH has one of the strictest protocols for AS around. You may want to talk to actual clinical urologists at other institutions before deciding against AS.

Sorry but I could not link to that article.

Hello dm1254,my stats were a little higher than yours.I chose CyberKnife SBRT.It will be 1 year out this March and my psa is going down,see signature.I have or had no bowel issues post SBRT.Sex life still continues and I still have ejaculate.Getting older does contribute to the rise and fall of the manhood.The 9 year study on SBRT compared to the 11 year study in IMRT was one of the reasons I chose CK.As you are getting more educated here on HW you will ultimately make your own decision on whats best for you.Side effects and invasiveness were the 2 things I wanted to avoid from the get go.Good Luck and keep putting your questions out there for us.SemperFi,John