I was recently diagnosed with prostate cancer from a needle-biopsy and PNI was noted in a GS6 =3+3 area of the prostate. My highest grade is GS7 =(3+4) in another area.
I am curious to know who else was identified as having PNI in their needle biopsy and was this taken into consideration for your active surveillance recommendations by your health provider?
I also had PNI in my biopsy and made these notes;
My Biopsy: "In pathology, perineural invasion, abbreviated PNI, refers to the invasion of cancer to the space surrounding a nerve. It is common in head and neck cancer, prostate cancer and colorectal cancer."
My Oncologist did give me a good analogy though, which made sense to me as an Engineer; if your Nerves were wires, they have insulation on them (a jacket) and its the insulation that has been "invaded," not the copper core below it...where the PCa can move back and forth...so PNI is not an indication that its inside the nerve system, but its found on the 'jacket' of the nerves inside your Prostate...that helped me...
BUT, I would not panic in your case...my tumor tissue was biopsied and I had a 4+3, with 60% GS4, so my case was a bit worse than yours...
I cant stress enough how much I would do different if I could go back...one thing that was not done for me was a good mapping of my prostate, my specific physiological / anatomical layout and where the disease was and was not...check out this YouTube...it has a lot on use of MRI and Ultrasound in mapping our disease...
The point which I tried to make to my Doctors (without success) was, that you cant manage what you cant measure. PSA rise and velocity, yada yada yada, got it...but there are a lot more tools in the box now a days than PSA...get mapped. Get scanned. Do a PSMA PET at some point. Get all your base line testing done NOW...bone densities, etc...put a stake in the ground of WHERE you are at this time...then monitor whatever you want going forward. You are gonna have to push for these tests and they wont volunteer them; the thought is, 'we'll deal with it when it presents...' But, that is flying blind and on your 'nickle'...my point has always been, that if you dont know where you are starting from now, how do you know if you are progressing, reversing , or staying the same (other than PSA; got it)...that would be my suggestion...check this YouTube out on MRI mapping...they are doing a lot more now than was done for me...my mapping was a rough hand drawn figure of my prostate on the back of my biopsy results with an "X" mark on it, showing where my cancer was...AND I paid for it...Cheers
The Anatomy of Success: Good Title...
youtube.com/watch?v=iX36cEc...
PS the DRE for surveillance in my humble opinion is a complete waste of time...it totally missed my disease which had grown to occupy 1/3d of my gland and not one DRE ever found it...long story...
Thank you Rmontana for offering guidance like you have. If it weren't for this community, I would be at complete mercy to the medical system deciding for me what and how my treatment should be done because of my lack of knowledge in alternatives. I am just beginning and have already encountered, without success, in asking for an alternative in a genomic test assay. I imagine similar challenges as I begin to meet with ROs, which I am not pursuing, until I get my second biopy pathology opinion back from Dr Epstein.
I found the video informative and sobering - much potential for acute and late term toxicities that are avoidable.
I had a whole pelvic 3T MP MRI before doing a biopsy, in hopes to avoid it. Maybe ROs can use my MRI too. I will ask them about mapping my particular unique anatomy to avoid avoidable toxicities while also getting the high curative doses necessary where toxicity is less risky.
About my observed PNI, I don't yet about my particular situation, if nerve infiltration is outside or inside the nerve sheath, and I do not know the consequences or treatment augmentation that may be required for either scenario.
Biopsies
MRI fusion Biopsy
Active surveillance?
