Perineural Invasion is present.

What does this phrase mean?

Just got the written pathology report, and was exactly the same as the oral report from the doctor except for this phrase, which he did not mention.

Is this something I should question further?

Thanks in advance.

 

It is kind of a controversial topic. I think a majority of doctors ignore it.

Theoretically, it is a pathway for the PC to escape the prostate through the nervous system. Many guys on here have had PNI, and have not had reoccurrence.

Goodlife

PNI was a concern to my doctor - he described the cancer as being "just ready to break out" at the edge of the prostate along side the positive margins - that is why he booked me in quickly for surgery and stressed the importance of post-op PSA testing.
It scared me, but as with other guys here at HW, having similar stats do not mean similar results.
Here's to a great post-op PSA result on Christmas Eve ( have posted a note to Santa for what you want for Christmas)
holiday hugs,
Bronson

I've seen this posted on many folks signatures and wondered about it.

My doc got the pathology back after surgery and said, "...for all intents and purposes, you are cured." I trust him... but that's not my experience with the cancers my grandparents had. Colon and pancreatic... but I'm adopted, so I don't know what my biological family had... besides PCa, evidently...

Anyway, I was G6, T2A, clear margins, encapsulated, neg lymph and sem ves. I guess I should ask about the peri invasion...

I posted a while ago an Italian study indicating PNI found in post surgery pathology reports had little bearing on BCR or survival comparing to pathology that did not have PNI. That may be why many doctors are not worry about PNI found in pathology report.

I guess that I am one of the unlucky ones. I had PNI and BCR 12 months after surgery. My doctor said not to worry when I questioned it. I think that you are more at risk with a higher gleason . I was a G8.

Tenpin -
May you have good results on Dec 24 ( 4 days after the start of Channukah) and may your Rabbi bring you and your family good tidings
(mind you, my foreskin grew back after my prostate cancer surgery) - I but I digress ...
-oy vey hugs,
Bronson

Tenpin,

"Newporter - Yes I saw that after my initial post. It seems that it's more of a concern in T3 or t4 cancers. (I was a T2c)."

It was actually for T2. By the way, I also had PNI in my pathology report and that was why I did my research. Here is a quick summary from Prostate Cancer Infolink:

A recently published Italian study has reported on whether perineural invasion (PNI) has prognostic value in patients undergoing radical prostatectomy for organ-confined prostate cancer, and on its possible correlation with other recognized prognostic factors.

Between January 2000 and December 2007, Masieri et al. carried out a careful prospectively designed study and collected data from 251 consecutive patients who had pathologically localized (organ-confined) prostate cancer after radical prostatectomy. Data from 239 of these
patients was usable for analysis. The authors defined PNI as adenocarcinoma observed within the perineural space adjacent to a nerve.

The results of their study showed that:

Intraprostatic PNI occurred in a total of 157/239 patients (65.7 percent).

PNI was more commonly observed in men with pathologic stage T2b/c (149/204 patients or 73 percent)) than in men with pathologic stage T2a (8/35 patients or 26 percent).
PNI was also more common in men with a Gleason score of 7 to 10 (73/93 patients or 78.5 percent) than in men with a Gleason score of 2 to 6 (84/146 patients or 57 percent).

Average (mean) follow-up was 65.4 months (range, 24 to 118 months).
11/239 patients (4.6 percent) had biochemical recurrence after surgery and 7 of these 11 patients (63.6 percent) showed PNI. 228/239 patients (95.4 percent) were free from biochemical progression after surgery and 150 of these 228 patients (65.7 percent) had
PNI.

The actuarial biochemical progression-free survival rate for all patients was 96.9 percent at 60 months and 93.5 percent at 84 months, respectively.

Stratification based on the presence or absence of PNI did not allow for identification of different prognostic groups.

The authors conclude that, at least in their series of patients, men with pathological stage T2 disease and PNI were found to present with a higher pT2 stage and Gleason score than men without PNI, but that the biochemical progression-free outcomes among these patients were
similar to the outcomes of patients without PNI at a follow up of between 2 and 12 years.

This study appears to suggest that the prognostic impact of PNI on risk for progressive prostate cancer is actually much lower than has been assumed in the past. It may well be that as men have increasingly been diagnosed earlier in the progression of their disease, that perineural
invasion is a less significant prognostic factor for men with truly localized disease than it has been thought to be for men known to have extraprostatic extension of their disease. In other words, PNI in men with pathological T3/4 disease may have greater prognostic significance
than it does in men with pathological T2 disease.