Perineural Invasion

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Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 10/22/2007 8:16 PM (GMT -7)   
Hi,
I just joined the group.  I am 65 and my wife and I reside in Southern New Mexico. I finally received a pathology report on my second biopsy in six months.  My PSA was 5.8 for the the first one.  The result was atypical cells.  The second biopsy was sent for a second opinion and revealed cancer in both lobes with a gleason of 6 (3+3)  It also indicated perineural invasion in the left lobe.  My PSA prior to the biopsy was 6.3.  I had a PSA 3 weeks later for my yearly physical with my primary care doctor.  The PSA had risen to 13 in that short period of time.  We are scared as hell right now.  My PCP said I should have surgery right away.  I was already considering RRP so I would be cancer free,  I will be seeing my Uro next week.  Any advice or suggestions?
 
 

41diagnosed
Regular Member


Date Joined Jun 2007
Total Posts : 176
   Posted 10/22/2007 8:39 PM (GMT -7)   
From another post from our Forum Moderator:

Bluebird said...

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>



I too had perineural invasion, and when I read it I literally got weak in the knees. It turned out to be insignificant and I had negative margins post surgery. Many others here will tell you the same thing.

Sorry to have to welcome you here, but as you will hear from lots of folks here too, "welcome to the club you never wanted to be part of". You will find lots of answers and support here.

The most important I learned was to take your time and educate yourself, and by all means, if you choose surgery, make sure you have a great surgeon. Many here found surgeons through referrals and research and did not go with the surgeon that diagnosed them. I know I didn't and am confident that it was a good decision.

The fear will stay with you for awhile, but don't allow yourself to make rash uninformed decisions. Your PSA is low and your Gleason score shows that you have a non-agressive cancer. You have time on your side.

Good luck on your journey and stay with us.
 
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 is...post 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...
 
 
 
 


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 10/22/2007 10:09 PM (GMT -7)   

Hi ~  Bootheel  & Loved Ones…

 

Welcome   to…   ~ HealingWell ~

 

and

 

A   Special   Warm Welcome  to  You !

 

Knowledge gives us POWER….  POWER takes away the fear.

 

~     ~     ~     ~     ~     ~     ~     ~     ~     ~     ~     ~     ~

 

Click  on  link  below for important information that will help you ~ help us!!

 

Welcome New Members ~ to HealingWell

 

The information (link) listed above is to help you get started on your journey.

It is a journey best traveled with friends.

Welcome ~ New Friend from all the members here... on HealingWell.com

 

v      IdahoSurvivor ~  Moderator for Prostate Cancer Forum

http://farm2.static.flickr.com/1160/1313099593_9f819e3ff8.jpg

 

v      bluebird ~  Moderator for Prostate Cancer Forum

http://i206.photobucket.com/albums/bb179/mamabluebird1955/mamabluebirdWelcome.jpg


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 10/22/2007 10:35 PM (GMT -7)   

Hi  ~ Bootheel,

 

Welcome to the Forum!

 

You have made a great choice to reach out to others in this forum.  Members of this forum have the ability to help your journey to healing become a little better and brighter.  In turn, your discussion and comments help all of us further develop our personal understanding and compassion. 

 

HealingWell will always be here for you…!  You are now part our forum family ~ a group of wonderful individuals who are willing to share and to care.

 

We’d like to hear and respond to anything you’d like to express.  So please, keep posting. 

 

My thoughts and prayers will be with you, as you make important, personal choices toward healing.

 

Kindest regards,,

IdahoSurvivor ~ Barry


"Idaho" ~ Barry

 

Da Vinci Surgery July 31, 2007… 54 on surgery day
PSA 4.3  Gleason 3+3=6  T2a  Confined to Prostate

1st PSA 0.04 (undetectable) 9/11/2007

My web site: http://pca-info.blogspot.com


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 10/23/2007 11:01 AM (GMT -7)   
Thanks Barry for the warm welcome.  I read your reply to Chas036 about removal of one nerve bundle during surgery and ED probability.  My diagnoses is similar to yours.  Did you have perineural invasion as part of the diagnosis.  I just assumed that it meant removal of that nerve bundle during surgery.
 
Thanks,
 

Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 10/23/2007 1:13 PM (GMT -7)   

Thanks for the good sound advice.  It has already made my stress level go down.  I am a little older than you but I still have good erections.  I can be happy with any results as long as I am alive, although  it would be a bonus to regain potency. Reading my post you know that my PSA doubled in one month.  I think it was the result of a biopsy (16 needles) about three weeks ago.  My PCP had my wife and I scared to death saying that I should have surgery immediately.  I think he should leave that decision up to my Uro.  I think his statement was based on opinion and not fact. We are still in shock over his comments.

Thanks again for the advice 

 

bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 10/23/2007 4:49 PM (GMT -7)   
tongue  Hi ~ Bootheel & Loved Ones,

 

Gentle Hugs and Warm Thoughts

 

We know ~ we can “all” make “Your Journey” smoother just by being here for you! 

This is truly a great forum!!! ~ You have joined!  You are now part our forum family ~ a group of wonderful individuals who are so willing to share...  It helps “all of us” ~ to help you ~ if we know where you are on your path. So ~ Please stay with us and take our hand when you need it!  Keep posting.... OKAY!!

  

 

KNOWLEDGE    IS    POWER  ...  and  POWER conquers  fear

 

YOU MAKE THE DECISIONS… YOU HAVE OPTIONS…

~ and ~

Your decision will be the right decision for you!!!

 

Thank you for letting us know the specifics… …this helps all of us to know where you are on your journey.

 

Buddy & I invite you to visit our personal thread listed in our signature below… We would like to help make a portion of your journey a little smoother.. so pull from us what fits your needs.

 

Make sure you visit the links in your Welcome Message from Idaho… there is so much information to help you through this….  This path is best traveled with friends.  The stepping-stones ahead will be smoother if you stay close to all of us.

http://i206.photobucket.com/albums/bb179/mamabluebird1955/Stepping-StonestoHealingWell.jpg

 

Keeping you close in thoughts and prayers ~ as you travel this new path with new friends.

In Friendship ~ Lee & Buddy 

 

"GOD Bless You"

It's a little prayer "GOD Bless You"...  but it means so much each day,

It means may angels guard you and guide you on your way.

 


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 :)


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 10/23/2007 9:59 PM (GMT -7)   
Bootheel said...
Thanks Barry for the warm welcome.  I read your reply to Chas036 about removal of one nerve bundle during surgery and ED probability.  My diagnoses is similar to yours.  Did you have perineural invasion as part of the diagnosis.  I just assumed that it meant removal of that nerve bundle during surgery.
Hi Bootheel,
 
My pre-surgery biopsy did not indicate perineural invasion.  My post-surgery pathology indicated that the tumor was contained in the prostate.  I was fortunate to find that the tumor post-surgery was smaller than expected from the pre-surgery biopsy results. 
 
Typically, doctors would like you to have surgery within four months of diagnosis when there is a chance of taking the tumor self-contained.  Considering how long it may take to get surgery set up with the hospital, and following the 6-8 week required delay after biopsy, your doctor may be considering "right away" to be inside this four month period.
 
Do you have a second opinion in mind?
 
Kind regards,

"Idaho" ~ Barry

 

Da Vinci Surgery July 31, 2007… 54 on surgery day
PSA 4.3  Gleason 3+3=6  T2a  Confined to Prostate

1st PSA 0.04 (undetectable) 9/11/2007

My web site: http://pca-info.blogspot.com


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 10/25/2007 9:21 AM (GMT -7)   
Bootheel,

The nerves referred to in perineural are not the same nerves associated with nerve sparing surgery. They are the nerves internal to the prostate. More urologist are now saying that perineural invasion in biopsies is meaningless. In fact, the Mayo Clinic will not even note it anymore in their pathological reports so I would not worry about it. My advice would be to get a second opinion on treatment options. The worse that would happen is an affirmation of your uro's recommendation.

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


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 10/25/2007 8:44 PM (GMT -7)   

Thanks for the clarification.  I am newly diagnosed and not familiar with all of the medical terms yet.  I feel a little more at ease knowing that there isn't a connection.

Thanks for your input

 
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