1. < Prostate Cancer

Help-what treatment plan has anyone selected for Perineural invasion?

Posted by thecure74 @thecure74, Mar 21 10:08pm

Age 74, diagnosed December 2024 with Gleason 4+4=8.
PSA 2.001 June 2024, PSA 2.28 4K Score September 2024.
October 2024, Prostate MRI PIRADS 4 High
December 2024, Biopsy 12 cores, two with Perineural invasion identified & a 3rd with high-grade prostatic intraepithelial neoplasia.
January 2025 PSMA Pet scan - Prostatomegaly with low-level relatively homogeneous tracer activity & PSA redraw 5.4.
February 2025 Decipher test indicates high risk

I am needing to decide on treatment:
Full prostatectomy including lymph nodes or Proton Beam radiation with 6 months hormone therapy.

Has anyone had this experience?

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heavyphil | @heavyphil | Mar 26 6:45am
In reply to @chippydoo "I have a buddy with G9 going with radiation. Will be interested how it works out." + (show)
@chippydoo

I have a buddy with G9 going with radiation. Will be interested how it works out.

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Chip, I really feel that age and possibility of recurrence should also be factored in.
If your age is advanced - I would say 75 and above - I personally would opt for radiation because the possible recurrence might take place after something else has already killed me🫣.
But if you are younger and opt for radiation as initial treatment, your choices are limited if it does recur; a lifetime of ADT or playing whack a mole with SBRT. It’s really an odds game, and frankly, a well informed gamble.

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1 reply
chippydoo | @chippydoo | Mar 26 7:42am
In reply to @heavyphil "Chip, I really feel that age and possibility of recurrence should also be factored in. If..." + (show)
@heavyphil

Chip, I really feel that age and possibility of recurrence should also be factored in.
If your age is advanced - I would say 75 and above - I personally would opt for radiation because the possible recurrence might take place after something else has already killed me🫣.
But if you are younger and opt for radiation as initial treatment, your choices are limited if it does recur; a lifetime of ADT or playing whack a mole with SBRT. It’s really an odds game, and frankly, a well informed gamble.

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Interesting thoughts. I think he is early 70's and in good health. I had removal in my late 60's followed and finished Salvage 3 weeks ago with G9 and no known spread. Initially on 6 months of ADT but suspect Doc will spring at least another 6 months on me. I was initially resistant as it would change some major things in my life. Short sighted on my part and more accepting at this point. I have been looking into the NCCN protocols. Thank you for your most welcome insights.

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Moderator
Colleen Young, Connect Director | @colleenyoung | Apr 2 5:40pm

@thecure74, have you made your treatment decision? What did you decide and what helped you make the decision?

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thecure74 | @thecure74 | Apr 2 6:55pm

Thank you everyone for your responses. I have chosen to go forward with proton radiation therapy and 6 months of Orgovyx due to the perineural invasion per the Mayo Clinic's treatment plan.

During the next two weeks I do the placement of the markers, SpaceOar, and CT/MRI positioning. After that, my 20 radiation sessions.

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topf | @topf | Apr 3 4:36pm
In reply to @heavyphil "The perineural invasion is not your worry - it’s fairly common. It’s the high grade epithelium/..." + (show)
@heavyphil

The perineural invasion is not your worry - it’s fairly common. It’s the high grade epithelium/ high Decipher Score risk that’s a concern.
Your age and overall health are VERY important in making your decision.
At 74, with some co-morbidities like brittle diabetes, hard to control HBP or advanced heart disease, radiation would be the better option.
However, if you are a fit and trim 74 with no other major health issues (uncontrolled by meds), surgery is a good choice because your type of cancer could return - no matter the initial treatment - and you could then do radiation/ADT to attempt a cure.
I just advised a friend NOT to have surgery at age 75 since his cancer is low grade, low Decipher and he has a lot of medical issues. Best,
Phil

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Why is HGPIN a big concern? It is still pre-cancerous, right?

@thecure74, are tou saying that 12 cores in the biopsy were positive? Or only those three you mention with PNI and HGPIN?

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1 reply
heavyphil | @heavyphil | Apr 4 6:06am
In reply to @topf "Why is HGPIN a big concern? It is still pre-cancerous, right? @thecure74, are tou saying that..." + (show)
@topf

Why is HGPIN a big concern? It is still pre-cancerous, right?

@thecure74, are tou saying that 12 cores in the biopsy were positive? Or only those three you mention with PNI and HGPIN?

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No, look at the other comments as well. HGPIN is precancerous - a concern, but not a huge one compared to the 2 cores of Gleason 8 with a high Decipher score. THAT is a much bigger concern.

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thecure74 | @thecure74 | May 4 5:37pm

The placement of markers & SpaceOar was completed with any major problems besides pressure down there. Way better than a biopsy!

The CT/MRI positioning went very quickly.

Headed into the third week of Orgovyx with no major issues so far.

First week (5 of 20) of Proton radiation completed. To date have not had any issues with bowel or bladder prep.

Overall, I am fatigued, some issues with urination and trying to keep my normal exercise and diet.

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