Location of cancer within prostate

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Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 7/29/2008 3:31 PM (GMT -6)   
I have read that many times the location of the cancer that is confined within the prostate (based on biopsy) should be used in determining a course of treatment.  Is this correct or misleading?  The reason for the question is that I have four cores that are positive:
Left Apex-10%
Left Mid Lateral-5%
Right Mid Lateral-30%
Right base-20%
The two areas -  R & L Mid lateral are what concern me.  These are the areas next to the nerve bundles I think.  Obviously I am wanting to spare the nerves.  If I elect surgery and due to the locations and percentage is there still a chance of sparing nerves (best guess).   And if I elect radiation, is the location too close and will that subsequently cause damage to the nerves?
I see alot of signatures that specify the number of cores, percentages etc, but not generally the location of the cores to base a judgement on.  And if none of this has any bearing what-so-ever, I would appreciate those comments as well.
Thanks in advance for your comments,
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

Veteran Member

Date Joined Nov 2007
Total Posts : 598
   Posted 7/29/2008 3:56 PM (GMT -6)   
Just to clarify - very rarely is there one tumor or cluster of cancer cells in a prostate. The cancer takes more of a Swiss cheese approach with multiple foci, or locations, of cancer - usually spread throughout the gland. The location of the cancer near the nerves if fine as long as there is not perineural invasion. As long as it's all contained, they usually spare the nerves. Radiation patients will have to answer the other Q's!
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  www.roboticoncology.com
Saved both nerve bundles.
Path Report:  Stage T2cNxMx
-Gleason (3+3)6
-totally contained to prostate,
-10% involvement in L & R Mid lobes
PSA 0 at six weeks
Pad free on March 14 - (10 weeks.)
ED - Take 100mg viagra every night.
Totally usable erections at 10 weeks.

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 7/29/2008 4:14 PM (GMT -6)   
Thanks Paul...I did have perineural invasion in the Base core...will that matter?
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 : 4462
   Posted 7/29/2008 5:06 PM (GMT -6)   
perineural invasion by itself is insignificant, by todays path. standards.  This usually only means that the cancer has extended into the nerve canals INSIDE the prostate, and have no relation to the exterior, attached nerve bundles that provide erections.  The perineural nerve canals provide a space for the cancer to grow into, and the cancer will take the path of least resistance.  Unless the cancer extends beyond the margin, which is the outer most gland and tissue that is being removed, then there's little risk.  I had the same thing, and that's how it was explained to me, and told not to worry about it. 
Here's a couple links to help you understand it better:
These provide a fairly easy to understand laymans description of the prostate testing and interpretation of the path. 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
7/31/08 ED- Viagra, pump continues, no response- Trimix .10ml x 2 weekly continues
Post Surgery PSA's:  3 mts-0, 6 mts.-0, 9 mts.-0.

Regular Member

Date Joined Apr 2008
Total Posts : 270
   Posted 7/30/2008 10:23 AM (GMT -6)   
Just thought I would let you know that I also had the same issue, that is I also had perineural invasion into the center nerve bundle at biopsy. I concur with James C. I also had 8 of 10 cores on both sides of my prostate with cancer and mine was a gleason 7. However, after surgery the pathology was good as shown below. There are no guarantees, but be encouraged you are still catching it early and chances are good the surgeon (if you go for surgery) will get it all. Blessings 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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