Looking for advice on Perineural invasion present

Posted by tstump12 @tstump12, Mar 6 5:10pm

I had my radical prostatectomy 6 months ago. Final diagnosis included Perineural invasion present, Carcinoma focally extends to right apical resection tissue edge and High grade prostatic intraepithelial neoplasion (HGPIN). Tertiary pattern 5 is present with a gleason of 4 + 3. Sounds bad. Not sure how bad. Anybody out there with some of the same type of diagnosis? I am looking for interpretation and any advice on next steps?

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I had "Perineural invasion identified" on my report but margins were otherwise clear. Unfortunately both our reports weren't optimal. What are your docs saying about the report, they must have discussed it with you on your surgical follow up, no?

If I'm seeing this correctly and understanding the HGPIN, those are essentially precancerous cells. They would indicate an increase in the risk of developing prostate cancer. That ship has obviously already sailed. You'd have to ask the docs if that's still an issue, meaning, can they still turn into cancer cells if you don't have a prostate? I don't know. Perhaps someone else here with more experience or who has done more research may be able to help on that.

In my case, there must have been some cancer cells still floating about after the surgery. My PSA started in the wrong direction and I was referred for salvage radiation therapy. My guess is the docs will simply keep an eye on your PSA for now and if it starts to rise, you'll be given next step imaging/treatment options.

For now I would just concentrate on getting back to a life as normal as possible and let the post surgery healing take place.

Best of Luck to you!

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I too had negative margins, no seminal vesicle invasion, but the presence of PNI. My Gleason was 3+4 = 7. My surgeon was not concerned as the data indicated the cancer was confined to the prostate. I did do some literature research and it appears to be a controversial topic as to whether PNI is an indicator of biochemical reoccurrence likelihood with many indicating it is not. This article gave me comfort that my surgeon was correct in not worrying about it. (https://www.advancesradonc.org/article/S2452-1094(18)30188-X/fulltext#back-bib13).

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Recent studies have shown that up to 84% of all surgical pathology slides contain PNI - there is NO evidence that PNI, in and of itself, presents a bleaker prognosis but rather it is simply found with higher Gleason scores. Personally, even my pre-surgical biopsy showed PNI in one whole half of the prostate with a 4+3 Gleason score. I figured I was a dead man.
My PSA now almost 5 yrs later is ticking up to .14.....so I am probably on the road to recurrence which will require ADT and radiation, but aside from the hassle, inconvenience and all that, it's not a terrible thing. I mean FIVE years post surgery is not 6 months so hopefully we are not dealing with a very aggressive cancer. I did not have the benefit of the Decipher test at the time but you should certainly have it done on your sample as it will indicate the aggressiveness of the situation. Best!

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@web265

I had "Perineural invasion identified" on my report but margins were otherwise clear. Unfortunately both our reports weren't optimal. What are your docs saying about the report, they must have discussed it with you on your surgical follow up, no?

If I'm seeing this correctly and understanding the HGPIN, those are essentially precancerous cells. They would indicate an increase in the risk of developing prostate cancer. That ship has obviously already sailed. You'd have to ask the docs if that's still an issue, meaning, can they still turn into cancer cells if you don't have a prostate? I don't know. Perhaps someone else here with more experience or who has done more research may be able to help on that.

In my case, there must have been some cancer cells still floating about after the surgery. My PSA started in the wrong direction and I was referred for salvage radiation therapy. My guess is the docs will simply keep an eye on your PSA for now and if it starts to rise, you'll be given next step imaging/treatment options.

For now I would just concentrate on getting back to a life as normal as possible and let the post surgery healing take place.

Best of Luck to you!

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Not getting much from my surgeon. Thanks for your answer.

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