Update: got pathology report: need some help

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Veteran Member

Date Joined Dec 2008
Total Posts : 673
   Posted 12/9/2008 11:50 AM (GMT -6)   
Hi All,
Got my pathology report, details are below.
One the cores shows "perineural invasion is identified". What does this mean in terms of treatment options? I've had some vicious perineal pain November/December 07, March 08 and yesterday. Took Septra/Bactrim before when it was thought to be prostatitis.
Does this rule out nerve sparing da Vinci? Does it imply radiation to follow?
Both my Uro and GP didn't mention this to my recollection.
Sheesh, that little tid-bit just scared the wits out of me.
Would be grateful for some insight here.
Biopsy Pathology: 5 of 8 cores positive, adenocarinoma in both lobes
1) 30%, GS 3+3, perineural invasion identified
2) 40%, GS 3+3
3) 60%, GS 3+3
4) 65%, GS 3+3
5) 30%, GS 3+3

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4462
   Posted 12/9/2008 12:19 PM (GMT -6)   
perineural invasion (PNI) is found when the cancer cells have grown into the openings and spaces around the perineural nerves inside the prostate.  Cancer is like water, it will take the path of least resistance, and these sheaths around the nerves in the prostate gives is a good place to expand to, usually there first rather than growing outward.  The nerves mentioned are in the prostate and hence the cancer is contained inside the gland, no more risk for extention  to margins, etc, than any other location inside the prostate.  PNI is so common in post-surgery path.  reports that a lot of pathologoists are recommending to not report it, as it is a common part of the cancer detection and diagnosis.  That it was found in a biopsy core sample is unusual, but not indicitive of any more danger or typing of the cancer. 
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.

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 12/9/2008 1:03 PM (GMT -6)   
Just as James mentioned...unusual on biopsy and pretty much normal on pathology after surgery. Only importance on biopsy report is for the surgeon if you go that route. Gives the surgeon some additional information to inspect closely depending on where the perineural invasion was located within the prostate. Mine was located near the base, so additional "close inspection" was performed during the surgery in that area. If you opt for surgery, your surgeon will make note of it, but otherwise...don't worry about this; it is meaningless for surgical prognosis or treatment choices.
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

Veteran Member

Date Joined Dec 2008
Total Posts : 673
   Posted 12/9/2008 1:35 PM (GMT -6)   
Thanks James and Les. I'm a bit "un-hinged" lately...not usual for me.

Thanks for the comments.

Biopsy Pathology: 5 of 8 cores positive, adenocarinoma in both lobes
1) 30%, GS 3+3, perineural invasion identified
2) 40%, GS 3+3
3) 60%, GS 3+3
4) 65%, GS 3+3
5) 30%, GS 3+3

Regular Member

Date Joined Jun 2007
Total Posts : 176
   Posted 12/10/2008 12:45 AM (GMT -6)   
James C is correct. But I had the same unhinged experience. Went down to U of Chicago to get my path report and read it walking in the hall. I literally got dizzy, ran into a bathroom, and thought I was going to puke when I read Perineural Invasion. It sounds horrible. I was sure then I was going to die from the disease. Called my wife on my cell and told her to look it up on the internet. So while I was sitting on the bathroom floor trying to keep from puking, she read to me that it meant absolutely nothing. I calmed down and moved forward.

Well, it's been a year since surgery and i'm dong well. So hang in there. It is likely completely inconsequential to your diagnosis.
43 yo. now
5/07 PSA 4.65 at routine physical
6/07 biopsy Gleason 7 (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 - RRP at Northwestern Memorial by Dr. William Catalona.  Thankful the father of the PSA test was right here in Chicago.
Post op path report confirmed Gleason 7 (3+4). 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...
12/31/07 - threw out the pads (I only had used 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.
9/17/08 One year past surgery and doing well.  PSA less than .1 and ED continues to get better and showing reasonably good results using Levitra which for a long time did nothing. 

Tim G
Veteran Member

Date Joined Jul 2006
Total Posts : 2331
   Posted 12/10/2008 12:57 AM (GMT -6)   
It's too bad that the physician didn't go over your pathology report in detail with you as mine did, answering all my questions.  
It can lead to the kinds of meltdowns that some have experienced when they read the report and don't understand all the terms or what they mean.
"Perineural Invasion" sounds like an army of prostate cancer cells have taken over and are ready to march throughout your body
PSA quadrupled in 1 yr (0.6 to 2.5)  
DRE neg  1 of 12 biopsies pos (< 5%) 
Open surgery June 06 at age 57
Organ confined to one small area Gleason 5   
PSA's undetectable  < 0.1  

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