Gleason score 3+4 plus perineural invasion

Not sure PSMA is nevessary for a 3+4. PNI is fairly common, I believe. You should consider a Decipher test for the risk of metastatic spread.

Perennial invasion is not a problem as long as you have the prostate treated.

You should be getting a PSMA pet test to see if the cancer has spread outside the prostate. This also gives you a benchmark against which future test can be compared.

According to a doctor at the latest PCRI conference “PNI and extra capillary extensions do not predict metastasis”

Have you had hereditary genetic testing? With your father getting the cancer so young, a genetic issue is possible and necessary. if any other relatives have had cancer in your family, that is also important to know I know at least three families where all the men got prostate cancer, but there was no “known”genetic reason. Has it been offered to you by a doctor? You can get it done free with the below link, if you live in the United States. Do not check the box that you want your doctor involved or they won’t send you the kit until they get in contact with your doctor. It takes about three weeks to get the results and then a genetic counselor will call you.
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Prostatecancerpromise.org

My urologist ordered PSMA for me (3+4, 6/12 cores, Decipher 0.56).

Since you have cribriform cells I would advise that you order PSMA scan and do not wait too long before treating your cancer. Those cells changed a lot comparing to normal prostate cell and should not be ignored regardless of gleason score - at least that is what I read and learned so far.

The literature seems to be all over the place about the prevalence of nerve invasion and its implications in prostate cancer.

I will definitely request a genetic test since it seems to run in the family.

Thanks for sharing. What is/was your treatment plan?

I did not have cribiform cells but they did find nerve invasion.

Thanks for sharing that study website - I'll sign up.

The report noted nerve invasion (called perineural). The literature seems to be unclear about how common this is with some rates in the teens and others reported to be upwards of 70% of cases. There are a lot of nerves in and around the prostate. There also seems to be disagreement about how nerve invasion could impact spread in the prostate In other cancers, it's a common avenue of spread as the cancer cells readily travel along the nerves spreading to other body parts. This leads to disagreement on how important nerve invasion is for making treatment decisions in prostate cancer. Some say no big deal and others say it is. Seems like an area that needs more research. I'm interested to see what my doctor says when I have the first follow up after the biopsy report.

Surgery in June, based on the recommendation of surgeon (John Ward) and ROs at MD Anderson. I have existing urinary issues that they felt made me a poor candidate for radiation.

I am wearing myself out trying to decide between Dr. Ward and Ronney Abaza in Columbus, OH. Ward uses a Retzius-sparing technique and Abaza takes an anterior hood approach - both seem to have similarly good early continence outcomes. I really liked Dr. Ward but the Houston logistics are a pain whereas Columbus is drivable and Dr. Abaza has done 6,000+ da Vinci prostatectomies. Cleveland Clinic is a last-minute dark horse based on a work insurance benefit I recently discovered that will pay for travel, lodging, and treatment. I requested a consultation with Jihad Kaouk but if he's not able to see me reasonably quickly, I'll probably forego that option. Clear as mud?

As I said in The previous message PNI is not considered a real problem by the doctor talking at the PCRI Conference two weeks ago. The Doctors that talk at These conferences really have a lot of experience. The Doctor said

“PNI and extra capillary extensions do not predict metastasis”

Essentially saying they don’t cause future problems somewhere else.