Gleason score 3+4 plus perineural invasion

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.

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?

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.

You speak with great authority here with definitive statements even making treatment recommendations. Are you a doctor? Is this in line with the guidelines of this forum?

Everything I can find in the research literature about PNI is mixed and I will wait to hear what my doctor says at follow up. I was hoping my post might elicit experiences from others who had similar pathology reports and what they did and what was recommended to them.

Hey bud, I too had extensive PI - figured I was a goner.
But my RO at Sloan actually co-authored a study on PI and the conclusion, very roughly expressed, was that it was a measure of how far laterally (and extensive) the cells have spread and NOT a measure of aggression.
Of course, lateral expansion implies capsular encroachment so that’s not a good thing either.
My surgical path showed a tiny break in the capsule, but margins and lymph were negative. Still, I just finished SRT so take every finding with a boulder of salt.
Phil

I quoted doctors in what I have said to you. I have recommended things that are standards of care with prostate cancer. When I give advice I almost always include, ask your doctor, unless the recommendations are for slight differences like Orgovyx over the other ADT options.

I have attended Advance prostate cancer weekly meetings at Ancan.org for about 4 years. During the meetings, they recommend treatments to people that are most likely to be standard of care. I also attend biweekly meetings with another group and monthly meetings with UCSF’s group. All of these meetings discussed treatments for people that have a need for options because many of the times the doctors they are going to are not following guidelines and under treating people. When I recommend different treatments, I almost always say ask your doctor, since I am not a doctor.

People need to have exposure to different treatments that other people are having that actually work. That’s one of the reasons they come in here, To get other options For their treatments.

I also have had quite a bit of experience with prostate cancer. I’ve had surgery and both salvage and SBRT radiation. I’ve had four reoccurrences, and with all I’ve learned during the 15 years I’ve had prostate cancer I can pass on a lot of first hand experience.