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Perineural Invasion
Pirads 4, 5 out of 12 biopsy samples carcinoma, Gleason 6, Grade 1, perineural invasion, Decipher score .55. Researching best way forward, leaning towards active surveillance. Comments from experience appreciated.
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Same as my Husband and that's what he is doing since 2020 he has a biopsy every year and very little changes but he is going to skip biopsy this year and do it next year because of the pain afterwards.
Prayers...
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2 ReactionsYou might want a second read on your slides by another pathologist. Although perineural invasion is not an indication that your cancer has spread, it does echo spread toward the outer periphery of the gland due to a large number of abnormal cells.
If that Gleason 3+3 is rediagnosed as 3+4 or 4+3 you might not be able to wait. Couldn’t hurt to be sure!
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3 ReactionsSo thankful your husband is doing well with active surveillance. Prayers that he continues doing well this year. Thank you for your reply.
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3 ReactionsMy Urologist did say after my Decipher test number came back, that I may have some 3+4 and 4+3 in there. He will be testing my PSA and doing an MRI in March. Thank you for your reply.
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3 Reactions@whitty1963 If it were me, with an intermediate risk from your Decipher test, I would be going for treatment. No doctor will be able to predict the timing of tumor growth. Even if you test every 3 months and then decide to get treatment, time is not your friend, necessarily.
If you consider radiation, you might want to think about a radiation machine with built in MRI such as the Mridian or Elekta, versus non-MRI built in machines that use fused images. Here is information about the Mirage randomized trial as presented from urology times: https://www.urologytimes.com/view/mirage-trial-margin-reduction-with-mri-guided-sbrt-reduces-toxicity-vs-ct-guided-sbrt. Toxicity and side effects are significantly different. Part of the reason is that the margins, the extra space around the whole process that is treated, is smaller with built in mri, (in my case 2 mm so less healthy tissue was exposed) vs 3-5 mm with non-MRI treatments.
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3 ReactionsThank you for your reply and the information you provided. I will definitely look into it. I hope you are doing well.
Focal therapies might be a good option for you. I was pirads 4, Gleason 7 (4+3) with perineural. I chose Tulsa pro at Mayo Rochester in July. My PSA went from 8.6 to 0.68 at three months. My story:
https://connect.mayoclinic.org/discussion/tulsa-pro-experience-mayo-clinic-mn-july-2024/