Last year I attended a webinar, where I heard the speaker (I don’t recall whether he was a urologist or an RO) say that he had never seen the presence of PNI changing a treatment decision:
> if the patient was considering a prostatectomy, PNI wouldn’t change that;
> if the patient was considering radiation, PNI wouldn’t change that.

Here’s a real-life example —> My oldest brother (78y) is starting his PC journey right now, He has PSA of 5.7, PIRADS 5, 4+3=7, with PNI, and they started him on Casodex, he just had his first Eligard injection on Friday, and will start 28 sessions of IMRT (70 Grays) in a month. I find that interesting because 4-1/2 years ago, at 65y I was diagnosed with PC, PSA of 7.9, PIRADS 5, 4+3=7, without PNI, and they started me on Casodex, Eligard injections, and 28 sessions of Proton radiation (70 Grays). So, we had pretty much the same diagnosis (except me being 13 years younger at the time), and yet him with PNI and me without PNI, and both of us have pretty much the same treatment regimen.

I’ve done a little more digging and found more articles on benign PNI as far back as 2005 and as recently as 2023:
> 2005: https://pubmed.ncbi.nlm.nih.gov/16096404/

> 2023: https://pmc.ncbi.nlm.nih.gov/articles/PMC10605475/

Seems like just one more ambiguous factor patients have to deal with.