Perineurial invasion - post surgery pathology report

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Regular Member

Date Joined Feb 2008
Total Posts : 42
   Posted 2/9/2008 4:23 PM (GMT -6)   
Hi everybody

I am new to the forum. I had my robotic surgery in January. 48 years old. pre surgery Gleason 3+3. Post surgery T2C NX MX , Gleason 3+3, no extraprostatic spread,margins negative. cancer was close to the left apex. BUT post surgery pathology report says, there is Perineurial invasion. At surgery apparently both nerves were spared. Does this mean that cancer can spread through the nerves now ? Please help. Any advice or comments would be very much appreciated.

Veteran Member

Date Joined Apr 2006
Total Posts : 1732
   Posted 2/9/2008 4:59 PM (GMT -6)   
Hi Positive,

The jury is still out on exactly what perineural invasion has to do with PCa spread ... IF it has anything to do with spread at all. Most studies say its significance is minimal.

Check out:
and Both are superior sites to do layperson research.

Regular Member

Date Joined Sep 2006
Total Posts : 211
   Posted 2/9/2008 5:17 PM (GMT -6)   

Some doctors feel that if perineural invasion PNI is present in biopsy, cancer might be more likely to have penetrated the capsule, however research by Johns Hopkins and others have not established any influence of PNI on prognosis, and some institutions do not evaluate PNI or place any great significance on it.

It seems that PNI has little if any influence on prognosis:  other factors of the  post-operation report are more important considerations.

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 2/9/2008 6:13 PM (GMT -6)   
Hi positivelife!
Welcome to the best site on the internet for first hand information on prostate cancer patient experience. PNI, like aus and swim stated, has an unsure significance. Mayo Clinic, and others have dropped reporting it on thier pathology reports because they find no use for the information worth mentioning. There are some doctoers who say that this could mean spread through the nerves, but there is no study to support it. More important is if their is lymph node involvement or positive margins. None of which you appear to have. So enjoy you way to a full recovery. You have probably noticed but there is virtually no limit as to what you can ask here, so drop in any time and ask away.

Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (1/08): <0.1
I will continue HT until May '09. 
Visit my Journey at:

Veteran Member

Date Joined Nov 2006
Total Posts : 1464
   Posted 2/9/2008 6:39 PM (GMT -6)   
Hey Positivelife,

You post-op path report is very much like mine. It looks like you are on your way to full recovery. Please stay us. We can all get well together...

Age 73. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Catheter out on 12/13/06.  Dry on 12/14/06.
Pathological stage: T2C N0 MX. Gleason 3+4.
PSAs from  1/3/07 - 1/17/08 0.00. 
Next PSA test on 7/17/08
"Patience is essential, attitude is everything."

Veteran Member

Date Joined Nov 2007
Total Posts : 598
   Posted 2/9/2008 6:50 PM (GMT -6)   
hey POS
48 here too. Welcome. This is a great place to be for all of us. Stay in touch. Sounds like you've found some answers that should give you peace of mind. Know what it's like...lying awake wondering what happened to your life! You will be fine.
take care
47 at Diagnosis.
Father died of Pca 4/07 at 86.
1/06 PSA 3.15
1/07 PSA 4.6      (Biopsy 3/07 just suspicious)
10/07 PSA 5.06   (Biopsy 11/07  1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC
Saved both nerve bundles.
Path Report:  Stage 2cNxMx
-Gleason (3+3)6
-totally contained to prostate,
-10% involvement in L & R Mid lobes

Veteran Member

Date Joined May 2006
Total Posts : 2542
   Posted 2/9/2008 8:50 PM (GMT -6)   

tongue    Hi ~ PositiveLife & Loved Ones ,


Welcome   to…   ~ HealingWell ~




A   Special   Warm Welcome  to  You !


Knowledge gives us POWER….  POWER takes away the fear.


~     ~     ~     ~     ~     ~     ~     ~     ~     ~     ~     ~     ~


 Click  on  link  below for important information that will help you ~ help us!!


Welcome New Members ~ to HealingWell


The information (link) listed above is to help you get around the forum! 


v       This is a journey best traveled with friends. 

Welcome ~ New Friend from all the members here... on


v      IdahoSurvivor ~  Moderator for Prostate Cancer Forum


v      bluebird ~  Moderator for Prostate Cancer Forum

Veteran Member

Date Joined May 2006
Total Posts : 2542
   Posted 2/9/2008 9:01 PM (GMT -6)   

tongue    Hey ~  PositiveLife & Loved Ones,

 Caring Enough to Share…..  


A   “Special”  Warm Welcome  to  You!


This is truly a great forum!!! ~ “You” have joined! You are now part of our forum family ~ a group of wonderful individuals who are so willing to share their journey.


Thank you for joining all of us on this road to HealingWell…..


KNOWLEDGE IS POWER... and POWER conquers fear


The sharing of your journey is so important for so many (including you!)…. 

Our Journeys ~ Good, Bad, and/or Scary ~ must be shared so we can continue to learn and move forward.  I’ve always felt that strength comes in numbers and this proves it!!! has 51,588 registered members and

HW’s Prostate Forum has over 22773 postings as I type this!  WOW!!!


Strength in Numbers!!!  Thanks for joining us!!!

Keeping you close in thoughts and prayers as you continue to move forward.

In New Friendship ~ Lee & Buddy


Here's a little more information ~

**Excerpts taken from “Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer”

by: Patrick C. Walsh, M.D. and Janet Farrar Worthington.   Copyright 2001


This book gave us so much knowledge… and Knowledge is Power. 


Page 145

**What about Perineural Invasion?

As cancers grow, they compress normal tissue, looking for “elbow room”—spaces with less resistance, where they can spread.  Nerves are usually surrounded by some empty space; for cancer, this is the real estate equivalent of a nice suburban lot with a big backyard—plenty of elbow room.  Thus, it’s not uncommon to find prostate cancer in the spaces around the nerves; this is called ‘perineural invasion.”  Because the nerves are most common close to the surface of the prostate, the findings of perineural invasion on a biopsy suggests that the cancer is close to the edge of the prostate, and may well have penetrated the capsule.  However—this is important to keep in mind—cancer that has penetrated the capsule can still be cured.  Which makes this a paradoxical finding—because, although men with perineural invaion are more likely to have capsular penetration than men without it, perineural invasion has no long-term impact on whether or not a man can be cured.  For this reason, some noted pathologists have suggested that it should not even be commented on when found in a biopsy, because it’s not worth worrying about.

mama bluebird - Lee & Buddy… from North Carolina


v          We invite you to visit our personal thread:  Click Here:  “Our Journey” ~ Sharing is Caring 

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy

PSA 4.6   Gleason  3+3=6    T2a   Confined to Prostate

3rd PSA 08-07-2007 Less than 0.1 Non-Detectable :)

Regular Member

Date Joined Feb 2008
Total Posts : 42
   Posted 3/7/2008 10:52 AM (GMT -6)   
Hi Bluebird,Tony,Swimom,Ans and Paul

Thank you all so much. My apologies for not replying earlier. Was going through a slightly bad patch emotionally for tweeny weeny reasons like incontinence the same time realising what a bunch of great guys and heroes you are all...almost everybody in this forum..Thank you,take care..Just heard about Tony's mum. Our prayers and condolences to Tony(TC-LasVegas)

Veteran Member

Date Joined Oct 2006
Total Posts : 626
   Posted 3/7/2008 11:48 AM (GMT -6)   

Just to clarify the nerves referenced in the PNI are those that are internal to the prostate not the bilateral nerves that were spared that are outside the prostate gland but attached to the periphery. As already mentioned you should ignore the PNI as a significant finding. Your chances of reoccurence are very low.

Diagnosed 7/6/06, 1 of 10 core samples, 40%,Stage T1c, Gleason 3+3
Da Vinci on 11/01/06, Catheter out on 11/13/06
56 Years Old
Post Op Path, Gleason 3+3, Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06, 6/25/07, 1/8/08
No more pads as of 1/13/07
Began injections in April '07

Regular Member

Date Joined Feb 2008
Total Posts : 42
   Posted 3/7/2008 12:58 PM (GMT -6)   

You clarified something which even the surgeon did not explain to me on my post op visit when I asked him about it. I suppose he wouldn't have spared the bilateral nerves if he saw anything suspicious during the surgery.
Thank you
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