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I would normally say with a Gleason 6 you don’t do anything, but the PNI means that the cancer has spread outside the prostate. Even though Gleason six, isn’t really considered cancer by many doctors, yours has pretty much proven itself to be cancer.
It could be that your Gleason score is higher, but they’re just not getting biopsy samples from the right area. My Gleason score was 3+4 before surgery and 4+3 after. I know people that have gone from 3+4 to 9 after surgery, So it’s hard to rely on the Biopsy all the time.
Both choices you have outlined would probably work quite well, But I suspect that if you have surgery, they would want to do IMRT radiation, since it’s already spread outside the prostate.
Are you being treated at a center of excellence? Getting opinions From more than one Radiation oncologist And urologist, Asking about the need for radiation after surgery, could give you more information about what direction to choose.
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Hey Jeff, I consider you “the man” on this thread as you have much personal experience with this disease and sit on other boards/blogs, etc.
However, please take a look at Dr Andrew Barsky’s paper on PNI. It can be accessed on the Memorial Sloan Kettering website under his credentials. He is my current doctor at Sloan and we discussed this paper at length. I do not think PNI always means that the cancer is outside the prostate, nor does it point to more dire prognosis as it once did. It IS a sign of the extent of disease inside the gland but doesn’t mean necessarily that the cancer cells used the neural sheath as a conduit OUT of the gland.
Anyway, just wanted to point that out to @packman7 so he doesn’t freak out any more than ‘normal’😊