Perineural invasion

berne

Looking to see what others have been advised about the prognostic value of perineural invasion (PNI) seen on prostatectomy pathology. Some articles indicate that it portends metastases and higher risk of biochemical recurrence, while others (more recent) seem to say more research is needed because by itself, PNI doesn’t necessarily predict a higher risk of mets or recurrence.

Post prostatectomy pathology report was Gleason 3+4, same low percent of grade 4 (less than 20% of all the tumor which itself was low volume) as the MRI-ultrasound fusion guided biopsy. The surgical margins, bladder, peritoneal fat, etc. were all negative for cancer. Frozen sections were sent intraoperatively so lymph nodes were not removed. Bilateral nerve sparing was done.

Unfortunately, the surgeon did not address the PNI seen on the removed prostate. He said there is an 80-90% chance that the prostate cancer is gone for good. I found that hard to believe given the report of PNI. My understanding is that there is a 30% chance of biochemical recurrence with favorable intermediate (Gleason 3+4).

jc5549

There are a lot of features in pathology reports that give us pause about the likelihood we will remain biochemically recurrence free for the years to come. I found Memorial Sloan Kettering’s prostate cancer nomogram in predicting prostate cancer status very useful. Although PNI certainly is an unfavorable finding (similar to cribiform pattern) it is less important then pre-surgical PSA and other surgical and biopsy pathology details. I have included the link below and hope this gives you a better feel for your predicted status 5-15 yrs post surgery.
I feel like you and I are in similar situations. Plug your numbers in and see what the nomogram predicts for you as an individual.
jc

https://www.mskcc.org/nomograms/prostate

swl1956

Perhaps a PSMA PET scan might be considered to further confirm of no spread?

berne

thanks so much for that prediction monogram. I hadn’t seen that before. MSK was the location for surgery, too. Interesting that PNI is not considered in their tool.

Clevelandguy

Hi,

Ten years ago I was diagnosed with PNI, 3+4. I had my Prostate removed by Robotic surgery and to this day I am undetectable. The only thing I am currently doing is a yearly PSA test which had been consistent @.05 for the last few years. My doctor had me on a std. sensitivity test for about 7 yrs. I plan to do no other tests or scans until my PSA starts climbing.

Dave 3+4

Steve1961

looks like you and I are in the same boat. Today I am celebrating one year cancer free. I had prostate surgery one year ago today. I am getting ready to go get my fourth PSA test. I have to admit I’m always worried but my pathology report came back just as clean as yours, except for PNI in invasion and the surgeon didn’t even acknowledge it, I had to ask him about it and he said he doesn’t think it’s anything to worry about he said 80% of surgeries have some sort of pni so there you go all we do is hope that we’re like Cleveland guy

Steve1961

If it ever climbs in my opinion you beat the devil you are a great inspiration to me and I hope to everybody on this form

LuckyKYGuy

Like Steve1961, my Urologist said the same thing. In my post biopsy consult he didn't mention it and I had to ask. He said that it really wasn't anything to worry about most of the time and that he's of the opinion that it may not even need to be included in the biopsy report. He assured me we'd find out on my final pathology if the cancer had escaped the capsule. Fortunately for me it had not….and the advanced testing shows there's an 85% chance I'll be cancer free for the next 15 years (which gets me to age 75) so I'm crossing my fingers.