ART PCRI Postponing Hormone Resistance and Perineural Invasion PNI
This podcast was of interest to me. I have perineural invasion (PNI) reported in both my prostate and surgical biopsy, reports. Likewise, I have a near maximum Decipher score for aggressiveness and cancer type lethality (0.97 out of 1.0) which required me to extend my hormone treatment using Lupron alone for an additional two years. I am concerned about both creating hormone resistance and PNI. This short presentation from the Prostate Cancer Research institute addresses both. You can never depend on any one report, but it's one more nail that I can hammer down while I look for others. For those who have interest.
Q: Is there an advantage to adding finasteride to hormone therapy for people with metastatic prostate cancer to try to extend time before hormone resistance:
A: No the different methods for postponing hormone resistance using hormones don't really make any difference
1.There's opinion that if you give Lupron alone, without Casodex that that might accelerate hormone resistance
2.Adding Finasteride with Lupron not effective; Finasteride has been shown to suppress PSA that comes from the prostate gland not from the PCa, cancer.
Q: Case study: Patient, RP 2 years ago, pathology clear, negative margins and clear vesicles…patient had Gleason 7 = 3 + 4 and the PSA is trending at 0.02. But he had perineural invasion (PNI) and he is very concerned that this would become a likely this will show that there's a likelihood of recurrence in the future.
A: Perineural invasion (PNI) is another in my opinion is a somewhat antiquated marker on reports on needle biopsy, pathology reports and on radical prostatectomy reports.
1.PNI addresses the fact that, microscopically the Pathologist could see the cancer cells inside the prostate growing along the surface of nerves.
2.This used to correlate in people that had surgery with cancer that could grow along the nerve and then outside the sides of the prostate, resulting in a positive margins.
3.Surgeon didn't get all the cancer out with the re section, so this was also thought to possibly be an indicator for somewhat more aggressive cancers.
4.We now know that it does have some minor relevance but when you look at all the other more important things like Gleason score, the size of the tumor, how high the PSA is and what not…
5.The presence or absence of perineural invasion doesn't change the future in any way whatsoever. PNI is one of these parameters gets included into reports, like a lot of other things, that does not significantly impact the overall outcome of the treatment.
