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Perineural Invasion after robotic radical prostatectomy

Posts: 1
Joined: Oct 2015

Hi all, I'm new to this web site and i thought that maybe some of you cancer experts/survivors could answer or give me some info on post prostate removal biopsy with perineural invasion means as far as further treatment. I just had radical removal two weeks ago and will have the foley removed this week. First the statistics from before surgery:

Before surgery: PSA in Jan 2015 at .4; at annual checkup in July, PSA is 16, PSA is 13 in August (to confirm it was high and not a lab error). ; Biopsy revealed one core at 20% adenocarcenoma at left apex only;all other 11 cores had no cancer; Prostate at 50 grams. Gleason is 3+3.

After surgery: pathology report;No cancer found in the following areas; bladder neck, pelvic lymph nodes both sides, seminal vesicles, right and left ureteral margins, just glandular hyperplasia with prostatic atrophy, prostate at 50 grams. However, cancer found on both sides and TNM upgraded to pT2c, pNO, pMX (n/A). Upgraded Gleason score to 3+4 from 3+3; and perinueral invasion present in 75% of gland. So now I'm wondering if I will need to go through more treatment because of the perineural invasion. Since my PSA was 13 and 16, I worry the next step is an adjuvant radiation treatment to clean up the bed area and hormonal to starve any escaped cancer cell convicts. I have read that nearly all prostates have perineural invasion, just present about 50% of the time but I noticed a mixed bag about whether it warrants any action. Some say it is a highway to cancer escape, other experts are unconcerned and say don't worry about it.

What have any of you seen with regard to survivorship with perineural being present. I read an article that it means recurrance is almost assured in 3 to 5 years if nothing is done. Need some advice on whether to consider radiation or let ir ride for a few years to see if PSA comes back, then do something about it. What do you think???

stoniphi's picture
Posts: 54
Joined: Mar 2015

...but not now, as the doc removed all of the nerves becasue they had been invaded by the cancer. Normal prostate is around 25 grams, mine was 35 after removal. It had expanded as the cancer grew and it enveloped the nerves as it did that. Yeah, if the doc had left them, the cancer would cheerfully have refired - up from the "neoplastic perinueral invasion". I got radiation and ADT as well. (my PSA was 11) pT3c N0 M0, G7(4+3).


The differnce with the radiation is this: get it done now and they will call it "adjuvant radiation therapy" wait for it to recur and they will call it "salvage radiation therapy". The difference is that you let the surgery fail before going to ADT.

Max Former Hodg...
Posts: 3699
Joined: May 2012

Welcome, Texasman.

I had surgical removal in January, so my study of this is relatively recent. Perineural invasion means that there is at least some chance that cancer cells escaped the gland.  I have never before heard the observation that perineural involvement is "irrelevant" or "nothing to worry about."  Worry, I suppose, is what we do best.

Knowing that, I would begin radiation of the prostate bed at the first opportunity.  You are already looking at at least some incontenence and impotence anyway, so the side-effects may worsen things a little, but probably not terribly much.  And it might save your life.  Plus, your PSA was relatively high, and a PSA above 10 at the time of removal is one risk factor for recurrent disease in the future. Certainly speak to a few oncologists, and definitely a radiation oncologist for his opinion; preferrably a guy who has a lot of expertise in salvage radiation.

Prostate cancer, compared to most other types of cancer, is extremely hard to localize once it relapses, even with some of the best, most recent scans.  The presumption now is that any escaped cells will be close to the gland bed, or adjacent lymph nodes.  If you wait, knowing where the cells probably are become problematic, if not impossible.

My layman's take of the situation, lacking any medical training,



stoniphi's picture
Posts: 54
Joined: Mar 2015

what Max said. That is also my understanding, though I am not a doctor either.




Old-timer's picture
Posts: 196
Joined: Apr 2011

I am unfamiliar with the term perineural invasion. Otherwise, based on my understanding of your description of your cancer, I think your condition is OK. See what happens during the next three or six months.

I offer no advice at this time.

However, I wish to encourage you. I had your readings (3+4 Gleason) when I had RP 24 years ago. I have experienced a few downs but many ups since I was diagnosed with PC. I am 89, physically and mentally well and in high spirits.

Best of luck to you.

By the way, did you mention age? I have always consiodered age as I made cancer related decisions.

Jerry (Old-timer)

stoniphi's picture
Posts: 54
Joined: Mar 2015

...means that the cancer has put out projections that have entered the nerves that run accross the prostate. Those projections are the "neoplasms" (from "neoplastic") that have invaded your nerves. It has been established that neoplastic invasion is a means for the cancer to metasticize and spread. If the nerves that have suffered perinueral invasion are left behind - "spared" - the chances of it spreading from those are very high. If the invasion was only moderate, the docs may opt for followup radiation therapy instead of removing those nerves.

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