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Posted 6/19/2017 7:16 PM (GMT 0)
Hi Everyone

I found this article and it got me thinking is it just me or do surgeons/urologist only factor the gleason and PSA when giving options to patients. I know when my husbands biopsy came back only the PSA and the Gleason were discussed, there was no discussion about nerves, PNI (which was present on the biopsy) the significance of the quantity of cancer in each core etc. Maybe this is the norm but after reading posts here past and present i think its important for the newbies to ask more questions and become more educated before deciding on treatment. The below article (i can't vouch for the source but it does quote hopkins) was very interesting to me. It would have also been nice to have known this when going through the decision making process. The other thing that has struck me is that the tumor quantity on the final pathology didn't get any attention from our surgeon when discussing it. He portrayed the final pathology as favorable and while its not necessarily bad news, im thinking an RO apt might not be a bad idea to be prepared.

http://malecare.org/perineural-invasion-on-prostate-biopsy-does-it-mean-that-i-have-advanced-prostate-cancer/
Posted 6/19/2017 7:53 PM (GMT 0)
Doire,

PNI is a relatively minor risk factor compared to stage, Gleason score and PSA, which is why it doesn't affect the risk category. A biopsy detection of PNI is riskier than a pathological detection (which is very common). It's something to acknowledge, but unless the patient is on the fence, not a determinative factor.

The pT3A is much more concerning, but there is no cause for action until the uPSA shows something.
Posted 6/19/2017 8:21 PM (GMT 0)
Thanks TA as always.

See that article was saying that PNI is not given enough "credit" when making decisions and when your newly diagnosed and not sure which way to go, i figured it counted then. Whats your thoughts on tumor size on final pathology. Shouldn't that be taken into account too after surgery? Or is it "standard" with all urologists to wait and see with high volume tumor?
Posted 6/19/2017 8:52 PM (GMT 0)
Hi Doire,
ive been trying to read a ton on PNI. TA is so thorough on everything its pretty astounding!

http://www.drcatalona.com/quest/quest_spring07_4.asp
"Many pathologists who examine prostate cancer biopsies believe that perineural invasion* (PNI) is present in all radical prostatectomy specimens if a careful search is made. " He feels that the nerves have something special that attracts Pca to them.

I hope they find out what that is and unleash the immune system response to destroy them in the future!!!

Btw...hows your Hubby doing? and when do you guys go out to get the first PSA done? Im itching to find out myself.
Posted 6/19/2017 9:09 PM (GMT 0)
Doire, The sources cited in that article are from 20 years ago.

While that does not make it invalid, there have been significant advances in surgery, radiation, and chemo since then, and I would also want to see some newer studies on PNI.
Posted 6/19/2017 9:26 PM (GMT 0)
Not meaning to hijack this thread, but is it safe to assume that if there was no mention of PNI on the biopsy or surgical pathology report, that it wasn't present?

My husband is also stage PT3a and has been undetectable since surgery 3 years ago.
Posted 6/19/2017 11:57 PM (GMT 0)
Doire-

As you say, the Malecare article is about PNI on biopsy, not pathology, and the one is very different from the other. As I said, it is a very common feature on path reports, but much less common on biopsies. Because a random sample of a few biopsy cores is not likely to find PNI unless there's a lot of it, it gets our attention when some is detected. On a path report, it is very much related to tumor volume and has no independent prognostic significance. The important things are stage - is the tumor contained or not, and grade -how aggressive it is. Once the whole prostate can be examined, it is no longer necessary to predict things like stage, upgrading,and tumor aggressiveness - we know exactly what was going on. That is the big advantage of surgery over radiation - in radiation, we can only use those prognostics to guess at what was going on.

mjw11- that is certainly a feature the pathologist is supposed to identify.
Posted 6/20/2017 2:26 AM (GMT 0)
Thanks everyone for the input and mjw11, so glad to see a fellow t3er doing great!

@ddyss nice to meet you! Hope your doing well. hubby doing really well, was continent right after removal of the CATH so he's one of the really lucky ones. His surgery was not nerve sparing so ED is an issue but we hope to speak to the Uro in July to see what we can do, right now he is on viagra Which hasn't made much of an impact sad. He actually did his PSA test today so I am hoping they will upload the results to the online system they have, but wouldn't be surprised if he hold the results until the scheduled apt on the 5th! It's been a long 3 months for first PSA! How have u been since your surgery? Your results mid July? Crossing my fingers for you!
Posted 6/20/2017 12:53 PM (GMT 0)
Doire, All the best for the first PSA! hope you see a lot of zeros's.

Im mostly fine ...continence improving ... Doc says he will start talking ED after first appointment in August...my right nerves were not spared so its going to be a longer road.

Yeah...my first PSA will be mid July!
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