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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’😊
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You are correct. PNI Does not mean it has spread outside the prostate. It does, however, seem to mean the cancer is aggressive. I see multiple statements about PNI, from NIH and others, that are similar to this.
“Prostate cancer has a propensity to invade and grow along nerves, a phenomenon called perineural invasion (PNI). Recent studies suggest that presence of PNI in prostate cancer has been associated with cancer aggressiveness.