Perineural Invasion: what is the best way forward?

@whitty1963, you might also be interested in this related discussion:
- Looking for advice on Perineural invasion present https://connect.mayoclinic.org/discussion/looking-for-advice-on-perineural-invasion-present/

How are you doing with the treatment decision making?

You and I are very similar in current status of PCa. I will be tracking your posts and replies. Reluctant brothers…

I am not a physician (retired chemical engineer); so all I can share is my experience and my research into low/favorable intermediate risk PCa, since my diagnosis 15 months ago.

68 y/o…prebiopsy PSA of 7.8…original mpMRI showed 3, 4 & 5 PIRAD lesions…biopsy in Oct '23.

7/15 cores positive…five 3+3 (5-10%) & two 3+4 (10-20%). Decipher CG Model “Low Risk" (from GRID report)…score 0.22. One 3+3 core (involving 5% pattern 3) showed perineural invasion.

Began AS in Nov ‘23…AND made sustainable lifestyle changes since then…increased running regiment to 3-5k’s/wk, modified diet and lost 25 lbs. VO2 Max increased from 40 to 47 in 15 months.

Post biopsy PSA’s have averaged 6.3….12 mth mpMRI showed largest lesion shrinkage and T2 & DWI/ADC signals reduced from “moderate” to “mild”. The other two lesions were not visible.

Initially I was motivated, but that didn’t last…I did find, however, that continued determination is sustainable.

I have modified my plan many times…and continue to do so…this approach requires adaptability.

I continue to research definitive treatments and I’m prepared, should my surveillance data move in the increased progression direction….but that’s not what my data show at this time….

IMHO, whatever you choose to do make sure you’re at peace with it.