New Member - perineural invasion ?

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SHU93
Regular Member


Date Joined Aug 2008
Total Posts : 326
   Posted Yesterday 9:53 AM (GMT -6)   
I just joined!! Been researching about perineural invasion. Saw some posts on the mesage board but had some more ?'s. Below is my brief history, then my questions. Thanks!
 
In May at age 36 I took a PSA test based on family history (Father, Uncle, and Brother) and it was 4.17. Went to Urologist who put me on Leviquin for two weeks. During visit did a DRE and was OK. Two weeks later did another PSA: 3.9. Suggested Biopsy which came back 6 out of 12 postive all on right side where the DRE checks! My biopsy exerience was very unpleaseant. Blood clots were very alarming and painful! It seems like hit or miss some people have no issues while others do. Then took a battery of tests CAT Scan (OK), Bone Scan (OK), Prostate MRI (OK) Not sure how I made it through this test, and Cystoscope (OK)
 
4 Weeks ago had the robotic (daVinci) Surgery. Post pathology came back that it was in my left side as well, which the Uroligist mentioned that it shows the biopsy is not defintive test and I was lucky it showed up on right side. My post-op pathology was a T2c, lymnodes neg, seminal neg, contained in prostate capsule. My Gleason went down from a 7(3+4) to a 6 (3+3). 
 
Recovery: my inconsistence is getting better but I wake up in the middle on the night alot to go bath room and I dont drink anything after 7pm because if so I wake up with a bladder full and in alot of pain until it is relieved. No erections yet, on Viagra 25mg a day.
 
In my post op pathology report stated perineural invasion in right lobe. Have read alot about that if perineural invasion in biopsy indicator of possible it escaping the prostate capsule. Does anyone have any info what it means for me with negative margins, and contained in capsule? When I go back to Doc will ask but he seemed very happy about results that I was cured. I am very concerned about reoccurrence especially based on my age no real data I saw on 30 year results just see 5 and 10...
 
THANKS, and LIVESTRONG!
 
 

Age 37
 
Diagnosed 7/2008
Da Vinci Surgery 7/2008
First PSA : 4.17 5/2008
Second PSA After 2 weeks of antibiotics : 3.9 6/2008
DRE: Negative 5/2008
Bone Scan/CAT Scan: Clear 7/2008
Cystoscope: Normal 7/2008
Prostate MRI: Normal 7/2008
Biopsy : 6 out 12 Postive all on right side, Gleason 7 (3+4).
PostOp: T2c (On Both sides), margins clear, seminal clear, nodes, clear. Gleason 6(3+3).
First PostOp PSA: 9/2008


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted Yesterday 12:36 PM (GMT -6)   
SHU93  Sorry for the need to even join this club but welcome anyway.  PI (perinueral invasion) is quite common on post surgery path reports.  So much so, that normally they aren't even documented by most pathologists on the post surgery report.  The prostate has many nerves that run throughout the interior as well as exterior of the prostate.  The space around the nerves inside the nerve sheath is a place where PCa cells migrate towards.  More room to grow if you like.  Regardless it doesn't mean a thing.  At one time there was a study that thought it might mean something when found on a needle biopsy prior to surgury but since has proven not to  be significant.  I had is show up on my needle biopsy and was concerned like you.  But if you research you will find that this is certainly nothing to worry about.  Your gleason score, the PSA and the path report showing clear margins and all the other tests you have done give you a very high positive outcome for being cured and those are the items that are important to look at.  Heres hoping to a bunch of zeros on your follow-up PSA's in the future.
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
Robotic Surgery scheduled Sept 18, 2008


Navy corpsman
Regular Member


Date Joined Aug 2008
Total Posts : 61
   Posted Yesterday 12:57 PM (GMT -6)   

SHU93-

You are the youngest person I have come across with PCa.  I am a little older but in the same ballpark, statistically speaking.  From what I can gather, nobody really knows about reoccurrance. It is possible for it to come back after 20-25 years.  Our post-op pathology reports are very similar and my doctor said I have about a 4% chance of the cancer coming back.  I feel VERY fortunate that I caught it early.

I don't know about perineal invasion, but I think you are ok. I'm sure someone who posts here will know. 

The odds are that something other than prostate cancer will cause our demise. Stay in touch.

- John


Age:  44
We have a family history of PCa.  My Dad and uncle died from it at 65 and 53. My PSA velocity increased in the last 2 years and I had to talk my GP into refering me to a urologist.
Biopsy results:  5 of 11 cores positive, all 30%. Gleason 6. T1c. PSA 2.53  Date of biopsy 15MAY08.
Open RRP at Johns Hopkins with Dr. Partin on 09JUL08.
Pathology report:  Gleason 6, pT2, neg. margins, 0 lymph node and seminal vessical, organ confined, I lost 1 nerve bundle and 22 lymph nodes.
As of today, about a month after surgery, I feel at about 80%. Urinary control seems to be improving. Little Elvis has taken a nap and has not awakened yet. I hope when he wakes up he is well rested because he is going to get one heck of a workout.
 
 


SHU93
Regular Member


Date Joined Aug 2008
Total Posts : 326
   Posted Yesterday 1:22 PM (GMT -6)   
- LV-TX Thanks for your response!!!

- John my Urologist performed over 2000 DaVinci Robotic Prostatecomy and I was the youngest. During the time pre-biopsy everyone including other urologists said at my age it is unheard of. But I am just happy I took the PSA and caught it. Only could imagine if I waited to 40 to get my PSA checked.

Any word on diets to follow to prevent reoccurrence?

Pray, and LIVESTRONG!!

Worry is like a rocking chair. It gives you something to do, but it doesn't really get you anywhere.


Age 37
 
Diagnosed 7/2008
Da Vinci Surgery 7/2008
First PSA : 4.17 5/2008
Second PSA After 2 weeks of antibiotics : 3.9 6/2008
DRE: Negative 5/2008
Bone Scan/CAT Scan: Clear 7/2008
Cystoscope: Normal 7/2008
Prostate MRI: Normal 7/2008
Biopsy : 6 out 12 Postive all on right side, Gleason 7 (3+4).
PostOp: T2c (On Both sides), margins clear, seminal clear, nodes, clear. Gleason 6(3+3).
First PostOp PSA: 9/2008


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted Yesterday 3:09 PM (GMT -6)   
SHU93-
37!! Wow! Good for you for being so on top of getting your PSA checked, but sorry for the outcome. I wanted to welcome you to HW and let you know that if you type in "pin" in the google search site at the top of the page, you should be able to pull up a few past threads on the topic. The "pin" question comes up pretty often and hopefully reading the threads will answer some of your questions. Keep us posted and best wishes for a cancer free future!
Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


SHU93
Regular Member


Date Joined Aug 2008
Total Posts : 326
   Posted Yesterday 3:23 PM (GMT -6)   
I ran a search within the site for pin, and the search hits I get are for Prostatic Intraepithelial Neoplasia, not perineural invasion.
 
Just ran a search on PNI and got hits. Thanks!!!!


Thanks,

PRAY & LIVESTRONG!


Age 37
 
Diagnosed 7/2008
Da Vinci Surgery 7/2008
First PSA : 4.17 5/2008
Second PSA After 2 weeks of antibiotics : 3.9 6/2008
DRE: Negative 5/2008
Bone Scan/CAT Scan: Clear 7/2008
Cystoscope: Normal 7/2008
Prostate MRI: Normal 7/2008
Biopsy : 6 out 12 Postive all on right side, Gleason 7 (3+4).
PostOp: T2c (On Both sides), margins clear, seminal clear, nodes, clear. Gleason 6(3+3).
First PostOp PSA: 9/2008

Post Edited (SHU93) : 8/20/2008 2:27:38 PM (GMT-6)


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted Yesterday 3:26 PM (GMT -6)   
Sorry...type perineural invasion. I got distracted while I was typing

SHU93 said...
I ran a search within the site for pin, and the search hits I get are for Prostatic Intraepithelial Neoplasia, not perineural invasion.

Thanks,

PRAY & LIVESTRONG!
tongue
Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


SHU93
Regular Member


Date Joined Aug 2008
Total Posts : 326
   Posted Yesterday 3:28 PM (GMT -6)   
Just ran a search on PNI and got hits. Thanks!!!!


PRAY & LIVESTRONG!
Age 37
 
Diagnosed 7/2008
Da Vinci Surgery 7/2008
First PSA : 4.17 5/2008
Second PSA After 2 weeks of antibiotics : 3.9 6/2008
DRE: Negative 5/2008
Bone Scan/CAT Scan: Clear 7/2008
Cystoscope: Normal 7/2008
Prostate MRI: Normal 7/2008
Biopsy : 6 out 12 Postive all on right side, Gleason 7 (3+4).
PostOp: T2c (On Both sides), margins clear, seminal clear, nodes, clear. Gleason 6(3+3).
First PostOp PSA: 9/2008


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted Yesterday 3:32 PM (GMT -6)   
You are welcome!! Hope it eases your mind a little!


SHU93 said...
Just ran a search on PNI and got hits. Thanks!!!!


PRAY & LIVESTRONG!

Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


SHU93
Regular Member


Date Joined Aug 2008
Total Posts : 326
   Posted Yesterday 3:37 PM (GMT -6)   
Yes, it seems like post-op it is not a concern if it was contained in capsule and margins were clear. Which was the case for me.
Age 37
 
Diagnosed 7/2008
Da Vinci Surgery 7/2008
First PSA : 4.17 5/2008
Second PSA After 2 weeks of antibiotics : 3.9 6/2008
DRE: Negative 5/2008
Bone Scan/CAT Scan: Clear 7/2008
Cystoscope: Normal 7/2008
Prostate MRI: Normal 7/2008
Biopsy : 6 out 12 Postive all on right side, Gleason 7 (3+4).
PostOp: T2c (On Both sides), margins clear, seminal clear, nodes, clear. Gleason 6(3+3).
First PostOp PSA: 9/2008


RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted Yesterday 4:18 PM (GMT -6)   
Maybe it is my age, but I know 4 men personally (one a family member) that have had their prostate removed more than 17 years ago and none have had any sign of return. They continue to do PSA's every six months. I asked one of them not long ago if they still got anxious about the PSA after all these years and they said no it really has become routine.

As far as perineural invasion. I had that ID'd on my biopsy, but interestingly enough on the pathology it stated their was no perineural invasion. Either way, if it is inside the area taken out by the operation it should not be an issue.

Best to you!

RB

Age 61
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA .04
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