Perineural invasion?

[weewillie131]

In the results of my recent biopsy I was a Gleason 8 in four cores and Gleason 7 in four other cores. Two of the cores had perineural invasion. Does this generally make it much more serious?

[Tall_Allen]

For you, it is a distinction without a difference because your Gleason 8 already puts you in the "high risk" category. Brachy boost therapy has the best outcomes for patients like you. The PNI means that whole pelvic RT and 18 months of adjuvant ADT should be used with it.

prostatecancer.news/2018/03...

[Hidden]

I too was 4+4 . It’s aggressive but it could be a 10. I went into remission over fours years ago with adt and imrt. Live right eat healthy and exercise often and you could live for decades . There is nothing nice for us or our families. But we deal with this . Best bet is to push it down in the first round.

[weewillie131 in reply to Hidden]

Did you go with radiation or surgery? Thank you!

[Hidden in reply to weewillie131]

Surgery never even mentioned.The horse was out of the barn T-4 .. My only choice was 8 weeks imrt plus double adt . It worked so far by some miracle .

[weewillie131 in reply to weewillie131]

My urologist suggests radiation since I have perineural involve ment. I am going to talk to a surgeon before I decide though.

[CalBear74 in reply to weewillie131]

Should you get a second opinion from a radiation oncologist? A surgeon is like a plumber every time he sees a drip he imagines a flood of water and gets out his tools. You end up paying For it.

[rscic in reply to weewillie131]

Good idea to get additional input. My impression is most distant metastasis (beyond the pelvis) is thought to be via the seminal vesicles. An additional impression I have is, one way the cancer escapes the Prostate is by way of crawling out along the path of nerves within the Prostate. This is why peri-neural invasion is important. To me this suggests possible Prostate Cancer in the pelvis, especially the Prostatic bed, but not (at least at first) spread beyond the pelvis. I had Gleason 7 (3+4) Prostate Cancer in 11 of 14 cores with peri-nueral invasion. I had RP (Radical Prostatectomy Surgery) and at Pathology microscopic Extra Prostatic Extension (cancer through the Prostate Capsule around the Prostate) as well as microscopic Positive Surgical Margins. 14 lymph nodes were taken at surgery and all were negative for cancer. I received Adjuvant Radiation Therapy to kill any cells that might have escaped the Prostate. With a study now about a year old some are forgoing Adjuvant Radiation Treatment and waiting for a possible BCR (BioChemical Re-occurrence = increasing PSA) before Radiation Treatment (then called Salvage Radiation Therapy because a BCR has occurred). I gave you this back-round so you might know more about a possible treatment path & better formulate questions to your Urologist and/or Surgeon. As with Wimpy-p if there is evidence the cancer has significantly progressed, surgery may not be an option. From your post I am not sure you are there yet.

[weewillie131 in reply to Hidden]

I don't know your age but at 68 I am very fit and active. Either cycling or ishing every day.

[Hidden in reply to weewillie131]

I’m now 59 but have fought this for five years now. I’m active also. Good luck

[j-o-h-n]

Greetings WW,,,Would you be kind enough to give us a wee bit more of your bio. Got your age of 68, Location? Treatments to date? Treatment center(s), Doctor's name(s). Thank you!!!

All information is voluntary but it helps us help you and helps us too. If you do reply it's a good idea to add that data to your home page, for your use and for members to view.

Keep posting here.... it's a great site....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 07/21/2020 7:17 PM DST

[Hidden in reply to j-o-h-n]

Oui, oui!

[weewillie131 in reply to j-o-h-n]

No treatment to date. Mri and biopsy in the past couple weeks. Two bone scans a week from today.Besides my Gleason of 8 my Psa is around 30. I live in west central Fkorida and my urologist is Dr. Desai of Advanced Urology in Homosassa Springs . They have offices all over this area and each one is used for a specific test such as mri, biopsy, surgery, radiation etc. I'm really nervous about the bone scans but I havent had pains any where so I guess that is good. The waiting..Ugh! My 8 core samples had high percentages of cancer 60-80%. My Dre was normal thru all of this so I don't take much stock in them. I appreciate the advice. Helps my nerves.

[ctflatlander in reply to weewillie131]

I'm GL 8 and T4 and mets to bone. Dre was normal with PSA34. 3 yrs into it @76. Stay tuned to this forum Double ADT, IMRT and SBRT to the bone am somewhat stable. Eat healthy and exercise.

[Muffin2019 in reply to weewillie131]

No bone pain is good but you may still have mets, I had no pain but had 4 mets, chemo made them shrink and now healed, bone scan is very useful .

[j-o-h-n]

Thank you for your quick response. Hey we all were nervous and still are when we have an appointment to see our Medical Oncologist. BTW you may want to see a Medical Oncologist besides your Urologist. Ask here if any members can refer you to a good MO in your area. Keep posting here and remember Pca is a slow growing disease.....Most men die with it than from it......

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Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 07/21/2020 11:20 PM DST

[leach234]

It is unclear whether perineural invasion increases risk for recurrence. Some say it does some say it doesn’t. Gleason 8 doesn’t mean the end of the world. If your abdominal and pelvic CAT scan and full bone scan are clear have the surgery. I was a Gleason 8, had surgery, and 2 years out my PSA is <.02. Just went from PSA test every 4 months to every 6 months. No ED and no incontinence. Like it never happened!

[leach234]

This site is for people with metastatic cancer so many did not have the option for surgery. Keep that in mind. If you can have surgery that’s the way to go. You can always have radiation afterwards if you need it.

[dmt1121]

I am not sure what you mean when you say you are Gleason 8 in four cores and Gleason 7 in four others. Cores are typically rated 1-5 based on the level of deviation from normal (5 being most deviation) and the the patterns and associated scores of the first and second most common patterns are added together for a single Gleason score (i.e. 5+3=Gleason 8).

I am not sure how you got both a Gleason 8 and Gleason 7 score.

[Brianbcollins in reply to dmt1121]

I have three cores with cancer out of 12 cores that were removed, 3 + 3, 3 + 4 , and 3 + 5 , so I have Gleason 6, 7, and 8. ( have I been calculating this wrong?)

[dmt1121]

The pathologist selects the most common pattern from all the biopsies and then the second most common pattern (each has a number grade assigned to it) and these are added together to get a single Gleason score. You only end up with one Gleason score, not two or three.

Read this which describes both a Gleason score and Epstein score: medicalnewstoday.com/articl... and youtube.com/watch?v=1Q7ERNt...(Not working as expected?)

If you are still unsure what your Gleason or Epstein score is, you should review this with your urologist and/or oncologist and have them explain it. You should also consider getting a second opinion from John's Hopkins pathology lab which may change your score. pathology.jhu.edu/departmen... (Dr Epstein is the pathology lab head for urology)