perineural invasion

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doting wife
New Member


Date Joined Oct 2007
Total Posts : 9
   Posted 10/14/2007 3:45 PM (GMT -7)   
   
 
     Have spent the last couple of days reading many of your posts.  It has been very helpful.  We have been home now for a couple of days following da Vinci Prostatectomy.  Now we are waiting for the path results on Friday.  I don't know which  is worse waiting for surgery or waiting for the test results.  Mike was 2.9 psa, 3+3 gleason 2 out of 12 positive. One less than 3% and one less than 20%. My worry is one said perineural invasion is identified.  The Dr. said that has no bearing on the outcome and is commom.  If that is so, why do they include it in the diagnoses.  Has anyone else had this on their pre treatment biopsy.  Just wondering if anyone could shed some light on this for  me.  Mike doesn't really want to discuss it at this point.  He is doing well recovering from surgery,and is finally getting rid of some of the gas.  That has been his biggest problem.  Thanks for all your help and support.    Pam

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 10/14/2007 5:03 PM (GMT -7)   
Pam,
I would bet that almost 70% here had PNI. The presence of PNI and its effect is contraversial. Most with PNI are never affected by it. PNI is an indication that there is a path from inside the prostate to escape. Thus if you don't have positive margins, then it was still posible that cells escaped the prostate through the nerve lining. It is unlikely, however as the most common way cells begin to escape is through positive margins. After talking to several oncologists, it is moot in my case. I had four positive margins so the PNI does not matter. Below is a web description.

http://www.diagnosis.prostate-help.org/perineu.htm

Tony
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.
 
STAY POSITIVE!


mvesr
Veteran Member


Date Joined Apr 2007
Total Posts : 823
   Posted 10/14/2007 5:29 PM (GMT -7)   
HI doting wife. My first urologist told me I had it and because of that it indicated the cancer was outside the prostate. He suggested external radiation and seed implants. I wanted surgery of some kind to get the cancer out of me. My second urologist who did my surgery told me it did not mean that it had escaped. I had negative margins and my first PSA after surgery was less than 0.01. Reading the posts from other people should make you feel better, but you never know the outcome until you get your pathology report after surgery, but think positive and trust in God and what ever the outcome we are all here for, and with you.

Mika

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 10/14/2007 6:44 PM (GMT -7)   
Hi Mika,
Every doctor and oncologist I have spoken with would not make the same assessment that your first urologist has made. And since most with PCa have it and most never develop those stated results I would have to agree with your second urologists opinion. But certainly Amen on the rest.

Tony
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.
 
STAY POSITIVE!


doting wife
New Member


Date Joined Oct 2007
Total Posts : 9
   Posted 10/14/2007 6:46 PM (GMT -7)   
TC-LasVagas,Mika Thank you both for your information. I can't tell you how much this helps to be able to talk to someone about this!! I will keep reading and posting and trying to be positive. Thanks again. pam

Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 10/14/2007 8:20 PM (GMT -7)   

I read somewhere recently that the Mayo Clinic has stopped reporting PNI on biopsy results because they do not believe that it has any impact upon the type of treatment that is chosen.

Tamu


Diagnosed 7/6/06, 1 of 10 core samples, 40%,Stage T1c, Gleason 3+3
Da Vinci on 11/01/06, Catheter out on 11/13/06
56 Years Old
Post Op Path, Gleason 3+3, Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06
No more pads as of 1/13/07
Began injections in April '07
Undetectable PSA on 6/25/07


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 10/14/2007 11:51 PM (GMT -7)   
Hi Tamu,
I posted a link above that indeed has that study at Mayo as a reference. Here it is again...

http://www.diagnosis.prostate-help.org/perineu.htm

Tony
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.
 
STAY POSITIVE!


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4461
   Posted 10/15/2007 6:41 AM (GMT -7)   
Ditto, I had the same thing on mine.  The doc explained it just meant the cancer had spread to the center of the lobe, internally, and had nothing to do with margins and such.  So, I'd say relax.  Sounds like a clean surgerical removal to me.  lol

James C. 
 
Help support the forums so they can support you:  http://www.healingwell.com/donate 
 
Age 60 
4/19/07   PSA 7.6, referred to Urologist
4/26/07   3 wks of antibiotics/anti-inflam.   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. Decision made for Retropubic RP
9/24/07   Retropubic Radical Prostatectomy performed 
9/26/07 Post-op Path Report: Gleason unchanged 3+3=6 Staging pT2c,
Prostate 110 gms, 2.2"x2.2"x1.75"
10/9/07  - Catheter out, no leaks, good control, so far, so good-
11/15/07  1st PSA scheduled


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 10/15/2007 6:50 AM (GMT -7)   

Hey ~ Pam,

Here's another bit of information that may calm your fears... until you know for sure ~ pull all the positive strength you can from all of us!!!  Continue to stay close.

In Friendship ~ Lee & Buddy

**Excerpts taken from “Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer”

by: Patrick C. Walsh, M.D. and Janet Farrar Worthington.   Copyright 2001

 

This book gave us so much knowledge… and Knowledge is Power. 

 

Page 145

**What about Perineural Invasion?

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 invaion 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.  For this reason, some noted pathologists have suggested that it should not even be commented on when found in a biopsy, because it’s not worth worrying about.

<end quote>

 


mama bluebird - Lee & Buddy… from North Carolina

 

v          We invite you to visit our personal thread:  Click Here:  “Our Journey” ~ Sharing is Caring 

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy

PSA 4.6   Gleason  3+3=6    T2a   Confined to Prostate

3rd PSA 08-07-2007 Less than 0.1 Non-Detectable :)


doting wife
New Member


Date Joined Oct 2007
Total Posts : 9
   Posted 10/15/2007 9:31 AM (GMT -7)   
bluebird,and others thanks again for the information. This site has been a God Send!!! pam

mvesr
Veteran Member


Date Joined Apr 2007
Total Posts : 823
   Posted 10/15/2007 4:28 PM (GMT -7)   
Yes TC, that is why I got a second opinion.

Mika

StrictlyInc
Regular Member


Date Joined Dec 2006
Total Posts : 353
   Posted 10/15/2007 5:27 PM (GMT -7)   
Count me among those that had perineural invasion, but negative margins. My urologist said he doesn't think info about perineural invasion should be included in post-surgery reports anymore, and is more of a vestige of past thinking about how prostate cancer spreads, rather than anything definitive.
____________________

Prostate cancer diagnosed: May 15, 2006 (age 40)
Gleason score: pre-surgery 3+3=6; post-surgery 3+4=7
daVinci radical prostatectomy: July 25, 2006
size of tumor: approx 1.1 inches; negative margins from surgery

- number of pads/day at 3 months after surgery: 3 to 5
- number of pads/day at 4 months after surgery: 1 to 2
- number of pads/day at 6-12 months after surgery: 0 to 1

- 1st post-surgery PSA: 0 (Nov 2006); 2nd post-surgery PSA: 0 (Feb 2007)
- 3rd post-surgery PSA: 0 (May 2007); 4th post-surgery PSA: 0 (June 2007)

The search for timber: took Viagra/Cialis approx. every other day, ErecAid once a day, injections. Peyronie's diagnosed 7/5/07. Now on Cialis, L-arginine and pentoxyfylline, ordered to be celibate for 6 weeks.

- PGE1 batting average: .364 (4 for 11)
- Bimix batting average: .500 (4 for 8)
- Trimix batting average: .500 (1 for 2)

"Lost in the valley without my horses, no one can tell me what my remorse is..."

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