Perineurial invasion. 1 out of 10 samples cancerous. Treatment?

PNI refers to the nerves inside the prostate and is very common. If there is no extracapsular extension, surgery can spare both nerve bundles.

“Everything looks good” doesn’t tell enough. If there’s no cancer, the report should say something like “benign,” or “no tumor present,” or something like that. You should ask specifics about the biopsy results. That will help track any progression going forward.

If “1 out of 10” samples was cancerous, they would have given that one sample a Gleason score. (In the biopsy report, what was the exact wording about that one sample?)

If there’s no cancer, then there’s nothing to treat or risk to spread.
> What is his PSA?
> What led to him getting an MRI and a biopsy?)

Treatments are always guided by the numbers:
> Total PSA; % Free PSA;
> PSA Doubling Time; PSA Density
> MRI results; biopsy results
> PSMA PET scan results
> genomic and genetic tests
> other diagnostic tests as needed

Is there a history of prostate cancer in his family?

The side-effects from treatment can be severe. If he has no symptoms and has no numbers indicating concern for cancer, I would simply keep tracking PSA regularly.

(I was 56y when I was diagnosed with PC; it was localized, 3+3=6, no other issues. I chose active surveillance; was on active surveillance for about 9 years. Then had proton radiation treatments when my PSA continued to rise and Gleason went to 7. My wife panicked when she heard about the 3+3=6; said she couldn’t stand the thought of cancer being in my body. But, I showed her the data that a true Gleason 6 doesn’t metastasize, and that active surveillance would allow me to wait and catch it early, and if it wasn’t a “true” Gleason 6, to still treat it. Here I am now, 13+ years later and it’s as if nothing ever happened. Our lives are completely normal. The first thing to control regarding prostate cancer are dark thoughts.)

Good luck!

That is truly bizarre. Perineural invasion means cancer cells are in/on the nerve bundle and THAT gets a Gleason Score! Also, they could be close to the edge of the gland, near the capsule and that does NOT ‘look good.’
“The doctor is very pleased” said my urologist’s receptionist when I asked about the grade of my bladder tumor. When I pressed her for an answer she simply repeated her script.
I got a new urologist that very day!
Get real answers, or get going… Best,
Phil

Sure that operation could be done. The question is does anything need to be done? One of the biggest mistakes people make is getting treatment when they don’t need it. He could live 10+ years without needing any treatment If they can’t even get a 3+3 Gleason score out of the biopsy.

You need to have a Gleason score, PNI doesn’t really mean that there is a serious problem. It is quite treatable.

If they didn’t find any cores with cancer In the biopsy then it’s possible they just missed it.

Did he have an MRI? That would show whether or not there were tumors inside the prostate. They would’ve given you a PIRADS Score on the tumors.

If you can’t get an answer from your existing doctor, you need to get yourself a second opinion from a center of excellence or a Genito Urinary Oncologist, They’re the ones that specialize in prostate cancer, Medical oncologist treat all types of cancer so they can’t specialize as much.

Omg I did not know that. I hope it’s within the prostrate and now I know that’s a possibility. Thank you!

His Psa was 5.6.
He gets that test yearly due to blood in his urine for the last 20 yrs where they can’t find a chase, so has been closely monitored for years.

I don’t know what his mri indicated.

His results showed 9 samples that were not cancer, and one that said “A minute focus of adenocarcinoma with Perineurial Nerve invasion”. No Gleason score given.

I’ll ask when I go with him to his appointment on Friday June 6th.

Yes, the MRI is very important. Also find out if he had a transrectal or transperineal biopsy.
A Trans - Perineal affords greater access to the entire gland and can get to areas the transrectal cannot reach without causing injury.
As @jeffmarc points out, there might not even be enough cancer to warrant Gleason scoring, but the words ‘adenocarcinoma’ and ‘perineural invasion’ usually are mentioned in a Gleason score framework.
At the very least get a second pathologist to look at the slides - very easy to have images/slides sent to a patho at a leading cancer center. Best,
Phil

To balance PNI

Yes, perineural invasion (PNI), while often associated with cancer, can also occur in other non-cancerous conditions. Considering the fact that the biopsy could not even come up with a Gleeson score could very well mean that this is not PNI related to cancer.