Jeff, I wish I wasn’t so bad at copying and pasting! The gist of Dr Barsky’s article is that PNI is NOT associated with post surgical Gleason upgrading. And that PNI offers - in a perverse way - a clearer look into the actual “Gleason-ness” of the original presurgical biopsy.
In my own case I had PNI in perhaps six cores out of twelve. I was diagnosed with Gleason 4+3 unfavorable. My surgical pathology report remained the same - no 5’s detected.
Of course, here I am 5 yrs later having salvage radiation so my cancer was obviously more aggressive. My doctors at Sloan however, ascribe this more to the surgeon’s laxness at doing complete lymph dissection than pure aggressiveness.
So the spread of the cells toward the neural sheath -PNI- does, in fact, point to a more aggressive type of cell but not one that has necessarily escaped into the surrounding tissues.
Best