Focal Perineural Invasion Identified?

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Elite Member

Date Joined Oct 2008
Total Posts : 25382
   Posted 10/27/2008 9:41 AM (GMT -6)   
Hello again, one and all:
I am now roughly 2 1/2 weeks away from my open rp surgery, so many thoughts running through my head.  One detail on my 3rd and final biopsy report still concerns me. On the left base biopsy section, it spells out "focal preineural invasion identified."  Still can't find a clear answer to what this really means, any particular significance, etc.  Should I be concerned, and did any of you in this group have the same notation?
I am dealing with a psa of 14.9 currently, up from 5.8 last july, and two known tumors, one is 4+3 and the other 3+4.
I have lost 24 lbs in the past 2 months without any excercise or deliberate diet, my wife, and LPN, thinks its all stress/nerve related.
Thanks for your help and support.  My thoughts are with all of you here.  Same war, different battles.
David in SC

Regular Member

Date Joined Apr 2008
Total Posts : 270
   Posted 10/27/2008 10:16 AM (GMT -6)   
I had perineural invasion on my biopsy but was clarified on the pathology as not penetrating the prostate wall. Here is the general definition from this web site:

"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 invasion 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."

There are also nerves going through the center of the prostate, and nerves surrounding the prostate. The location of the invasion is also important. If the invasion is within the interior of the prostate, the cancer will be removed even if penetrating into the nerves (if you are having RRP). If it is on the exterior of the prostate, your surgeon may cut a wider path. Even though shown on the biopsy, it still may not issue forth in a positive margin. Keep your chin up!


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

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 10/27/2008 11:51 AM (GMT -6)   
I had perineural invasion at the base on biopsy as well. RB above is correct in what he said. Only thing to add was my surgeon said he used that information to be aware of it during surgery so to not have any surprises as he put it. He didn't elaborate and really emphasized that it wasn't significant in the prognosis or surgical outcomes. So don't worry about it. You can find lots of threads on this subject here. Just put PNI in the search box above and read what others have said. - You will find a previous post in which I asked the very same question.
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
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA Oct 08 <.05

Elite Member

Date Joined Oct 2008
Total Posts : 25382
   Posted 10/27/2008 1:21 PM (GMT -6)   

Thank you Les and RB for the info. Just hard not to think about all the details, especially since I have been laid off as a CFO for 3 months now, on top of dealing with the PC.

David in SC

Regular Member

Date Joined Sep 2008
Total Posts : 78
   Posted 10/27/2008 1:55 PM (GMT -6)   
My post-op pathology report also had "Perinueral invasion:Identified". The doctor told me this is very common and not to worry. Sorry about your job - what a bummer. I hope you find something real soon!

Rising PSA 12/06=1.6 12/07=2.1 5/08=2.6
Biopsy 6/4/08 Positive
Diagnose @ Age 51 Gleason 3+3=6
Bone & Cat Scans Normal
Lapro Surgery 8/18/08 at Memorial Sloan Kettering
Pathology report stage T2c organ confined with positive apical margin Gleason = 6 1/2
Catheter removed 8/26 - reinserted 8/29 - removed 9/2
No continence or potency problems.
First post op PSA 10/2/08 < 0.05

Veteran Member

Date Joined Apr 2008
Total Posts : 1132
   Posted 10/28/2008 7:37 AM (GMT -6)   
I lost about 10 pounds before surgery and 10 after. for me, it was all stress related. I am almost six month post surgery and have gained it all back. Initially, I thought it was cancer related but it was all stress. Good luck with the surgery.
Age 48
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
decision - surgery (robotic)
surgery may 9, 2008 - houston, tx
pathology report -gleason 8
margins clear
4 week and 6 week PSA >.04 (undetectible)
12 week PSA <.04
continent at 10 weeks (no pads!)
kegel's twice a day 20 reps

New Member

Date Joined Nov 2008
Total Posts : 13
   Posted 11/15/2008 2:19 PM (GMT -6)   

I was just diagnosed with PC on 11-11-08 which proved to be the most frightening day of my life.  I am 64 years old with my father having had prostate cancer.  My PSA was 3.3 and was just done last month.  There were 14 cores taken on my biopsy resulting in 7 samples with a Gleason score of 7, two with a 6, and 5 benign.  There was also one mid core sample with a focal perineaural invasion noted.


I am visiting a surgeon on Monday 11/15/08 that does what I believe is called a Divinci laparoscopic procedure.  My doctor says that my low PSA, and the small size of the tumors is a positive, and he thinks it is contained within the prostate wall with the possible exception of the one core mentioned earlier.


What are your experiences out their as I am very new to this disease.

Post Edited (Ivory63) : 11/15/2008 12:22:49 PM (GMT-7)

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4462
   Posted 11/15/2008 3:47 PM (GMT -6)   
Ivory63, welcome to the forum, hate to see ya Your journey is just beginning, but it can be moved along more quickly if you are ready for a bunch of reading. Your stats indicate early detected contained PCa and usually easily removed. The removal process is the big decision, of course. I would suggest you take the few weeks or so to do some in depth reading here, starting with some of the material listed in the 2nd from the top subject line above. This contains links to some of the info available, as well, as some of the Journeys of our members. If you have questions, ask them on a separate thread with the appropriate subject, to catch peoples attention.
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
Present- 1 year: ED- Viagra, pump continues, no response- Trimix .10ml x 2 weekly continues
Post Surgery PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 1 Year-.02.

New Member

Date Joined Nov 2008
Total Posts : 13
   Posted 11/15/2008 5:17 PM (GMT -6)   

Thanks James C

It's been less then a week and I am obviously very scared.  This site is helpful since everyone has experience with the disease.


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