Perineural Invasion

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Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 7/23/2008 11:06 AM (GMT -6)   
Had my first visit with the Uro yesterday to go over the biopsy in detail.  One of the cores that was at 25% showed preineural invasion (PNI).  I asked him if that was significant and he said not in selecting your choice of treatment except in the case of active surveillance which he didn't recommend anyway due to the percentage amount and number of positive cores.  Reading online, you get both sides of the equation as to whether this is significant or not in treatment choices and as well as reoccurance after treatment
So here are my questions:
1) If you had PNI in your biopsy cores...did it make a difference in your treatment choice and why.
2) If you had PNI in your patholgy report in event of surgery...did you have any salvage treatments.
How many of you had evidence of PNI in either biopsy or pathology and had a reoccurance?
Still on my search for choices of treatment....
Thanks all
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
Gleason (3+3) 6  Stage T1C
No Treatment Decided yet

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 7/23/2008 11:15 AM (GMT -6)   
I had PNI in my post-surgery path report, and had no further treatment.  PNI normally involves nerve  pathways inside the prostate gland itself, and is removed during the surgery, hence no future increase in cancer reoccurance chances in most cases.  I've seen it described as the nerve sheath's provides a void along their length and this is just what the cancer is looking for, the path of least resistance.  So it is natural that it would go that way. That's why PNI is so prevelent in path reports, and why most docs don't place any special significance in seeing it in a report. 

James C.
Co-Moderator- Prostate Cancer Forum

Age 61
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 (open) Retropubic Radical Prostatectomy performed
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
10/15/07 ED- begin 50mg Viagra and Vacurect pump nightly, Fully continent
1/14/08 Caverject started/stopped, aching. 2/24/08 .5ml Bimix started-success
7/4/08 ED- Viagra, pump continues, no response- Trimix .10ml x 2 weekly continues
Post Surgery PSA's:  3 mts-0, 6 mts.-0

Veteran Member

Date Joined Feb 2008
Total Posts : 1858
   Posted 7/23/2008 6:07 PM (GMT -6)   
I thought I remembered a discussion of this coming up a short time back. A very good post by BLUEBIRD can be found here.

1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07----4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.1 undetectable

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 7/24/2008 7:41 AM (GMT -6)   
Thanks all...after doing more homework, I found that it is very important to check the dates of publication at the top. Some times you will read something that is 10 years old and isn't relative anymore. Bottom line, seeing the perinueral invasion on a biopsy isn't relative anymore. It appears that PCa will find itself around those nerves in 85% of all cases and it was just a sampling by the needle during biopsy and is of no importance. I was thinking it was part of the nerve bundles that control ED but found it is the internal nerves instead.

This is a wonderful site...thanks all for the information
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
Gleason (3+3) 6  Stage T1C
No Treatment Decided yet

Regular Member

Date Joined Jun 2007
Total Posts : 176
   Posted 7/24/2008 8:22 AM (GMT -6)   
Sounds like you've figured it out.

When I read it on my path report, just the sound of it made my knees buckle...literally. I thought I was going to get sick because I figured it meant it had spread. But that's not the case. It's near irrelevant in your diagnosis. Thought used to be that if it was in the nerve sheath it could travel outside the prostate faster through that path. But the biopsies pick it up passing through a nerve inside the prostate, and it does not mean that it has spread. Many path reports no longer include it. Lucky us that ours did and gave us yet another worry!

If your PSA is relatively low, which it is...mine was 4.65, and your gleason is 6, that is what they will use to determine the chances of progression and extraprostatic extension. At the end of the day, it's all statistics anyway and all the options for treatment exist for you. Choose what you are most comfortable with. And it sounds like you are already doing your research which is great.

Good luck in your treatment decisions.
42 yo. now
5/07 PSA 4.65 at routine physical
6/07 biopsy positive for cancer...Gleason 3+4...diagnosed at 41 y.o.
6/07-9/07 manic research and interviews with physicians across the country in search of the "right" decision.  I went to Mass General in Boston, Loma Linda, University of Chicago and Northwestern.
9/17/07 - Radical Retropubic Prostatectomy Surgery at Northwestern Memorial in Chicago by Dr. William Catalona.  Thankful the father of the PSA test was right here in Chicago.
Post op pathology was Gleason 3+4 with negative margins, no seminal vesicale involvement, no lymphatic or vascular invasion, bladder and urethral free and tumor volume was 5% of 27.3g.  
9/27/07 - Catheter removal...let the games begin...
12/07 - Threw out the pads.  I only had to use 1 pad per day for protection against minor drips. 
I started Trimix 8 weeks after surgery with success.
I hope someday I won't need injections, but I hope more that my PSA stays at 0 forever.

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