Perineural invasion is not uncommon and does not preclude successful surgery, nor does it necessarily indicate local spread. Surgery might be a bit more extensive, but still very good outcomes.

Your husband unfortunately has IDC( intraductal carcinoma ) which is very aggressive feature according to papers and doctors. If you are not in a center of excellence you should find one and go there for second opinion on biopsy findings and proper treatment. Although perineural invasion is not of extreme concern it IS a concern and as you said yourself shows cancer trying to escape the gland. Ask for Decipher BUT be very proactive (as you are already), I would not personally wait for treatment. My husband unfortunately has IDC and cribriform gland formation and I understand your concern and worry < 3.

IDC, like so many things associated with prostate cancer, can vary considerably, so I would defer to conversations with your urologist. The main thing with prostate cancer is finding and treating it while it is still localized.

You definitely need to follow up with your physician(s) to discuss the specifics of the Intraductal carcinoma (IDC-P) found in your husband’s pathology report.

IDC-P is often associated with more aggressive prostate cancer.

Although some Gleason 3+4 can allow for active surveillance, the presence of IDC-P could shift the recommendation toward definitive treatments like surgery (prostatectomy) or radiation.

Here’s a few questions I’d be asking my urologist or oncologist, regarding the IDC-P finding:

• How extensive is the IDC-P, based on the current pathology report?

• Does the IDC-P observed in this report change the risk assessment in my particular diagnosis?

• Can you help me get a 2nd opinion on my biopsy pathology, especially focused on the severity of the IDC-P?

• Can additional tests (e.g., especially the Decipher genomic testing) help to assess the overall aggressiveness of the PCa, for my specific case?

• How does the current IDC-P finding, in my particular case, affect my treatment options or monitoring plans?

I wish you and your husband all the best, as you chart your path forward!