Perineural Invasion Noted on Post-op Pathology Report

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Regular Member

Date Joined Jul 2007
Total Posts : 242
   Posted 10/4/2007 7:35 AM (GMT -6)   

Hi all. I had a question about perineural invasion.

I'll assume that most know what perineural invasion is, so I'll spare the explanation, but although my biopsy report showed that there was no perineural invasion seen, my post-op pathology showed that it was present. However, my urologist told me that a high percentage of his patients’s post-op pathology reports showed perinural invasion, and that since my report showed that there was no capsular penetration, negative margins and negative seminal vesicles, that it was not a cause for concern.

Just wondering how many out there had perinural invasion noted on your post-op pathology reports, and what signfigance, if any, your doctor attributed to it.


Age: 49
Diagnosed: March 25, 2007
PSA: 3.0
Biopsy: Gleason 6, 5 out of 12 core samples positive for cancer with <5% on all 5. Staged at T1c
DaVinci Surgery: May 21, 2007 at Florida Hospital, Orlando. Surgery took 1 hour and 45 minutes. According to my surgeon, prostate peeled away nicely and everything went text book. Nerves spared.
Pathology Report: Upgraded to Gleason 7 (3+4), Negative margins, seminal vesicles negative, no capsular penetration, lymph nodes left intact, 15% of prostate involved by cancer.
1st Post-op PSA: <0.01
2nd Post-op PSA: Scheduled September 27, 2007.
Continence: Out of pads 5 weeks post-op. Still have some minor stress incontinence from time to time but it's not an issue.
Erections: Yes! With the assistance of Cialis.
Family History: Father diagnosed with prostate cancer in 1997 at age 67. Prostate removed and has had a <0.1 PSA ever since.

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 10/4/2007 7:56 AM (GMT -6)   
I had it and the doctor was not concerned. Of course the four positive margins and seminal invasion he was not as unconcerned with. PNI is common from what I have learned reading the posts here for a year. I have heard conflicting things about it. uI have always wondered why it is commonly downplayed by the doctors, yet it is still noted on a pathology report. PNI means that nerve tissue is affected and I have heard that some had the nerve bundles removed when it was detected. I still have both nerve bundles, but i had PNI. Go figure.


Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007
Post-Op Pathology was poor: Gleason 4+3=7, 4 positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
My PSA did drop out after surgery to undetectable.  It has not returned and I will continue HT until January '08.
My Life is supported very well by family and friends like you all.

Post Edited (TC-LasVegas) : 10/4/2007 7:00:40 AM (GMT-6)

Regular Member

Date Joined Mar 2007
Total Posts : 315
   Posted 10/4/2007 7:59 AM (GMT -6)   

I also had post-op path perineural invasion.  My urologist also doesn't think it would be a problem. He claims that since the invasion was found inside the prostate, that doesn't mean that it was also on the outside since I also had negative margins.  I have also read that the nerves are one of those paths of least resistant when the cancer is growing and needs room to escape.  I read in Walsh's book or Catalona's site that some pathologist don't even mention it on the pre-op biopsy reports as it has no significance on the outcome.

However if I had known about it before hand I would have insisted on taking as much as the nerves as possible and would have lived without the sex.  Like I have said before I would rather be a live steer than and dead bull!

diagnosed sept 06
gleason 3+4=7, right lobe only
psa 4.7
Told not to have surgery at Dana Farber as cancer had already penetrated prostate, in seminal vesicles, would have positive margins. Would only treat with radiation and HT
RP Emory Atlanta December 2006
Path-negative margins, negative lymph nodes
negative seminal vesicles, multifocal perineural invasion, both lobes involved
40% gland involved
gleason 3+4=7
1st psa April 2007-<0.04
 6 Mos PSA <0.04
9 mos PSA still <0.04

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4462
   Posted 10/4/2007 8:29 AM (GMT -6)   

I had the same thing, and agree with TCLasVegas and montee as to the reason given by the surgeon for this line on the path report.  The way I understand it, my tumor had left the flesh of the gland and had gotten into the neural pathway and was following that nerve sheath out.  It didn't get outside, according to the report, and thank God, but it was heading that way.  My doc said probably in six more months it would have emerged from the prostate into the margins.  Evidently it is common for this to occur, if you consider that the nerve sheath is surrounded by tumor in most cases. 

Here's the line from my report concerning it:

"Perineural invasion:  Microscopic intraprostatis perineural invasion is present" 

 As was explained to me in my post yesterday, the intraprostatis means inside or contained within. 

James C. 
Help support the forums so they can support you: 
Age 60 
4/19/07  PSA 7.6 , referred to Urologist
4/26/07  Urologist prescribes 3 weeks of antibiotics/anti-inflam. due to past history of Prostatis.  DRE- nothing detected but 'gross enlargement"
6/5/07    Recheck of PSA: 6.7, biopsy scheduled.
7/11/07   Biopsy- 16 core samples, ultrasound size of gland around 76 cc. Staging pT2c
7/17/07   Pathlogy report:  3 of 16 cancerous/ 5% involved, left lobe top, center, bottom, Gleason 3/3:6. 
8/3/07     Decision made for conventional RP surgery, scheduled for Sept. 24.
9/24/07  Conventional  Radical Retropubic surgery performed 
9/26/07 Post-op Path Report: Gleason unchanged 3+3=6 Staging pT2c,
Prostate 110 gms, 2.2"x2.2"x1.75"

Veteran Member

Date Joined Apr 2007
Total Posts : 823
   Posted 10/4/2007 7:09 PM (GMT -6)   
HI everyone. It was noted in my biopsy, so that is why my first urologist told me it meant that the cancer had escaped the capsule and I should have external radiation and seed Implants. I was not happy with that so I got a second opinion by the Dr. who took my prostate out. He said is was of no consequence. Had negative margins and first post op PSA was less than 0.1 So I guess I made the right decision.


Regular Member

Date Joined Jun 2007
Total Posts : 176
   Posted 10/10/2007 10:10 PM (GMT -6)   
Ditto for me. I had it too and it showed up on my biopsy. Doc said same thing as everyone's here...don't worry. Can't imagine why I would worry when someone says "invasion"... I supposed if it's not significant, they should come up with another name for it that sounds less ominous.
42 yo.
PSA 4.65
Gleason scores from 4 pathologies of the same biopsy with 2 of 12 cores positive for cancer (if this isn't confusing to the patient...):
1) both cores 3+4 (Weiss Memorial)
2) one 3+4 and one 3+3 (Univ. of Chicago Hosp.)
3) both cores 3+3 (Mass General Hosp.)
4) both cores 3+4 (Northwestern Memorial Hosp.)
9/17/07 - Radical Retropubic Prostatectomy Surgery at Northwestern Memorial in Chicago by Dr. William Catalona.
and the winner op Gleason score of 3+4.
Good pathology report with negative margins, no seminal vesicale involvement, no lymphatic or vascular invasion, bladder and urethral free and tumor volume was 5% of 27.3g.  Amazing how something so small can cause such problems!
9/27/07 - Catheter removal...let the games begin...

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4462
   Posted 10/11/2007 8:50 AM (GMT -6)   
My post op path report had the same thing, and my doc said the same thing.  It remained inside the gland, even if it did get out into the interior nerve areas.  I think that's one of things that most people see on their reports. 
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