perineural invasion, what is it and what does it mean/

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6090
   Posted 3/24/2010 10:07 PM (GMT -6)   
Lets get one going on this one. It seems when it is on your biopsy, it means there seems to be a greater chance of EPE. Makes sense! When it is on your post-prostectemy path report, what does it mean and why do so many prostate speciailist poo poo it as meaningless? Are they right?? Zufus I googled Dr. Strum and pni and he seems to be of the same mind, from what I read. That it is significant as prognosticater of EPE, but if the cancer is in fact organ confined, it, and I'm extrapolating here, it is as significant as an escape route as tumor created blood vessels and probably not as significant.. I suppose a cell or 2 could get squeezed out with a vigorous DRE or other prostate manipulation. Most solid immune systems seem to handle a cell or 2 of cancer or we would all be riddled with it.Like I said in an earlier post, I'd druther not have it on a surgical path report....... So what do the rest of you think? I notice a lot of newbies ask the question?. I know, I think that the nerves that are invaded are not the same as erectile nerve,as they are out side the capsule. They invade the space surrounding tiny nerves with in the prostate. Again this is my understanding. What understanding do you have. From my various research It seems a vast majority of surgical path's show it and a vast majority of prostectemy's do not have a BCR. Do we all just want to believe it is not significant. Does it even warrant its own post????
age 66 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of W Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
8 week psa 0,0


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 3/25/2010 6:09 AM (GMT -6)   
Logo, your assumptions are correct. PNI pertains to the nerves within the prostate and not the external nerve bundles. From what I have learned, PNI is a very common finding on both biopsy and surgical pathology reports. While it can provide a conduit for cells to escape, apparently it's not enough of a threat. My husband had PNI noted on both biopsy and surgical reports, and he did have a single EPE on the surgical path report. Was this caused by the PNI - who knows. The surgeon knew there was a risk of EPE due to the location of one of the positive cores - the picture he drew for us at the consultation showed 1 of the 2 cancerous areas right at the edge of the prostate. Fortunately, the surgeon went in with a plan and cut a much wider margin around that area to achieve a clean margin.

Interesting post, and I look forward to reading the responses.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009 - 0.1, September 0.3, October back to 0.0, December 0.0, March 2010 0.0. Next PSA in 6 months. Thank you God!


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 3/25/2010 6:17 AM (GMT -6)   
It is one possible way for PCa to leave the gland, apparently is not a definitive thing for patients found with such on their pathology report as to equating for sure as having systemic PCa. We have patients whom are apparently cured or looking cured, whom had the perineural invasion present in their biopsie(s). Also, have patients with low and safe looking stats, that failed surgery and/or some other methods on occassion. the reasons????

Again I mention PCa is full of inconsistencies, unknowns and undefinitives...and against this background we patients along with our docs, end up choosing a protocol that we hope is a cure. Maybe someone like Bostwick and expert pathologists guys whom should know more than we could, have something to say to us on this question..it is a good question. Maybe someone herein has web links that help discuss it more, I don't think what I mentioned is inconsistent with whatever is written about this, (LOL) but I did stay at a Holiday Inn last night. (ha-ha)
Youth is wasted on the Young-(W.C. Fields)


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2448
   Posted 3/25/2010 6:41 AM (GMT -6)   
Zufus,

You are right on the money and the HI stay probably didn't have anything to do with it. As always your posts are based on a very strong background of knowledge and research.

I think I fit into that category of those that have done all the right things, have had the great reports, been treated by some of the best in their field and still find that the fickle little bastiches have a mind of their own.

It is a carpshoot and that is for sure.

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
Gleason Score (3+4) 7 in all positive cores
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy

2/24/10 FIRST POST RAD PSA 1.1---CARRRP --waiting for the next test.


Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 3/25/2010 8:23 AM (GMT -6)   
Logo,  I think it is significant that MSK does not consider perineural invasion an important factor in their nomograms.  This is a link to one of their papers,  www.ncbi.nlm.nih.gov/pubmed/16192588?dopt=Citation.  But, I agree with Sonny and Zufus.  In the end, it is simply an individual thing.  It might and might not be important..
 
Carlos

Diagnosed 2/2008 at age 71, Gleason score 5+3=8, stage T1c, PSA 9.1. 
Robotic surgery 5/2008, nerves spared, All margins, SV and lymph nodes negative. 
Staged pT2c, Gleason score 5+3=8.  PSA <0.1 at 20 months, Jan. 4, 2010.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/25/2010 8:43 AM (GMT -6)   
I will repeat what I have learned through my own medical team. My own beloved uro/surgeon played it off as not being important, and I notice that with others, it is usually surgeons that do down play PNI.

However, after meeting with 3 different radiation oncologist, including the one I chose to work with, and with my former medical oncologist that handled my other cancers 10 years ago, all of them, all 4, feel that PNI is an important factor in considering having radiation.

They feel that these nerves are like giant out going sewer pipes, and all it takes is a few stray PCa cancer cells to exit on one or more of these nerves, and eventually, you will have micro metastis with ease, and once in the nerves, they can end up anywhere in the body over time.

It does give a somewhat compelling explanation why men like Sonny and others, have quickly failing surgeries and secondary treatments.

BTW, it doesnt mean your surgeon sucks, it just means the PNI allowed the possibility for the escape of cancer cells, whether it was a good surgery or even a great surgery.

In a low grade PCa case, and the primary treatment seems to have "cured" the problem, then PNI probably doesnt mean as much. For me, I am sticking by the advice of 4 different oncologists that I actually sat down and talked with.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days


deer hunter
Regular Member


Date Joined Jan 2010
Total Posts : 250
   Posted 3/29/2010 6:54 AM (GMT -6)   
I,myself believe as David does that PNI is a way for PCs to escape as told by the med.onc, my husbands surgeon wasn't as concered about it .But his PC showed up about 7 months later. Ithink PC just does what it wants to but i really wish it would go away!!!!!!!!!!!!!!!!! My husband is really having a hard time with it now .he worries about where it will show up next and it's been 3 months since SRT and he can't seem to get his strength back ,he started back to work in March ,Ithink it's good it keeps his mind off..[ the PC] His hips are stiff and they weren't before SRT.so Iknow that had something to do with the drs, don't tell you that ! sorry for venting Ijust got of the subject which was PNI
dx age 57 01/06 open RP 4/06 psa in 01/06 8.1  surgery path report Gleason 3+4=7 poorly differentiated  tumor was 90%involved in both lobes surgical margins postive. in the right apex and right radial margins tumor grade G3  perineural invasion present high grade of PIN found  T2c NX MX PSA 0706  .01 10/06 .02 01/07 .03 04/07 .04  06/07 .05  07/07 .08 07/07 bone scans pelvic ct neg. 08/07 proscintic scan neg.9/07 psa.10 net with rad onc. wanted to do SRT but i did not do it 10/07  saw a new dr at Emory University [my old dr urg. suggested second opinion ]  bone scans negs ct scans pelvics neg. biopies of the bladder and adrinal glands neg.another proscintic scan neg.12/07 Psa .11 clinial trial Emory injected with protons to try and find the cancer cells no luck 3/08 psa .17 06/08 psa .23 psa 09/08 psa .32 12/08 psa .39 3/09 psa .39 6/09 psa .43  meet with medical onc. he said  i might have waited to long to start SRT 7/09 psa .50  another bone scan ct scan all neg.MRI neg. meet rad. psa the last of 7/09was .55 onc. 7/09 started casdex 50mg 1 day for 30 days 2 shots of lupron started rad treament 10/09 40 treatments 75 gm 12 shots each time all aroud pelvic finished 12/09  psa .07 and psa 01/10.05 next dr visit 03/10 wait and see 3/10 psa.05


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/29/2010 9:09 AM (GMT -6)   
hello wife of deer hunter.

sorry he is still having a hard time. my SRT ended end of November, last year, so it has been nearly 4 months ago. i have about 1/2 to 3/4 of my normal pre-SRT strength and endurance. I still deal most days with some level of rectal/penile pain. I am waiting for my 2nd post SRT PSA test next week, really concerned and anxious about it.

in general, with the exception of my ongoing stricture and catheter problems, i healed up well from my open surgery. last year at this time, i was feeling and doing pretty good. had no incontinence, and no ED, and was getting my strength back.

from july till now, been a down hill battle. first, all the back to back stricture problems, but more importantly, i have never been the same since i went through SRT.

now the doctors say, it may take as much as another year, or more, to fully get over the effects, and according to my former medical oncologist, not my radiation oncologist, may not ever fully get 100% back from the radiation caused fatigue. I was told this before when I went through radiation 10 years ago, so I know that's probably true.

hope your husband gets out of this mental funk. we all do that at times, for different reasons. any cancer is tough to work through, and PC comes with too many twists and turns. it certainly doesn't play fair or by the rules.

vent all you like, that's an important feature of being here at HW, no one will ever get mad at you for that. PNI, stated my opinion above, is easy to argue it away, until your cancer starts to spread ,and then, suddenly, the thought of PNI makes a whole lot more sense.

Good luck, come and vent anytime.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 3/29/2010 9:56 PM (GMT -6)   
So Dave and DH's wife, what do your Drs say about PNI. Is it like postive surgical margins in that a re-occurence will likely be local, or systematic. Do the PCa cells that get out end up travelering or staying put. Is SRT indicated as an effectivetreatment if PNIis present or not.
Dx with PC Dec 2008, PSA 3.4, Biopsy: T1c, Geason 7

Robotic Surgery March 2009 Hartford Hospital
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Junl 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05

New Topic Post Reply Printable Version
Forum Information
Currently it is Tuesday, September 25, 2018 12:11 PM (GMT -6)
There are a total of 3,006,469 posts in 329,343 threads.
View Active Threads


Who's Online
This forum has 161835 registered members. Please welcome our newest member, scattycatty.
316 Guest(s), 8 Registered Member(s) are currently online.  Details
Georgia Hunter, HeartsinPain, mattamx, Admin, BillyBob@388, Jay79, Sahale, iPoop