Information requested - Perineural in... - Prostate Cancer N...

Prostate Cancer Network

3,277 members1,856 posts

Information requested - Perineural invasion (PNI) in needle biopsy

climb4blue profile image

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 were treatment recommendations by your health provider altered because of PNI?

15 Replies

Seems to be pretty common. Follows nerve endings. Thr pathologist I talked to at JH that did my second opinion of my biopsy did not seem overly concerned about it. I do think it is a risk factor though.

It is my understanding that PNI is the pathway for cancer to get to the bone.

rscic profile image
rscic in reply to sryoung44

My understanding is it is a way for the cancer to get beyond the prostate capsule (outside of the prostate). I found the "Discussion" & "Conclusion" in the below paper informative ....... bmcurol.biomedcentral.com/a...

climb4blue profile image
climb4blue in reply to sryoung44

I have not seen any studies correlating PNI to bone cancer. It is better to not assume from anecdotal instances for everyone’s sake, especially with such a dire outcome.

Epstein says having PIN does not affect the ability to perform Active Surveillance so to me that is saying it is not greatly signficant. see 58:26 in youtube.com/watch?v=XLvTaqB...

climb4blue profile image
climb4blue in reply to Anomalous

Thank you, but I am looking for help with something else. Not Prostatic Intraepithelial Neoplasia (PIN) or high-grade PIN (HGPIN), a precancerous lesion of the prostate.

I am looking for help about Perineural invasion (PNI), what health providers have altered in patient care for patients who have it.

Anomalous profile image
Anomalous in reply to climb4blue

that's what i meant. if you look at the video he says it doesn't affect whether you are a candidate for activate surveillance. which to me means it is not all that signficant. why else would it be ok to have it with AS.

video snip
climb4blue profile image
climb4blue in reply to Anomalous

Thank you Anomalous. The video is quite informative. Last week, I sent my slides to Dr Epstein for a second opinion. Dr Epstein does state that PNI is currently not as critical of a prognostic parameter as it once was given our current prognostic parameters, so typically will not change any particular therapy. Although around 38m:25s, he states that PNI is predictive of progression following external beam radiotherapy (XRT), which is a therapy I'd think a Grade Group 2 patient might choose but may not want to if there is a potential for progression after treatment.

After watching the entire video, I was able to go back and look for details in my pathology report to try and calculate my % pattern 4.

I was diagnosed with Gleason 6 and HGPIN at Johns Hopkins in 2009. Have been in their AS program ever since, with no progression of my pathology. No specialist has ever suggested that HGPIN would warrant treatment if all other findings indicated AS.

Thank you, but I am looking for help with something else. Not Prostatic Intraepithelial Neoplasia (PIN) or high-grade PIN (HGPIN), a precancerous lesion of the prostate.

I am looking for help about Perineural invasion (PNI), what health providers have altered in patient care for patients who have it.

Sorry for the mix-up. This quote and study may be what you are looking for:

"In summary, we present evidence that PNI is a strong predictor of lethal prostate cancer among men undergoing radical prostatectomy and describe for the first time an association between PNI and prostate cancer-related mortality in a cohort without definitive treatment. Our findings, in concert with those from previously published studies, suggest that PNI should be a standardized component of the pathologic review of radical prostatectomy specimens and that this finding may identify another group of high-risk patients who may benefit from adjuvant therapy post-RP. Further research into PNI may shed light on key mechanisms underlying the metastatic potential of prostate cancer."

ncbi.nlm.nih.gov/pmc/articl...

Anomalous profile image
Anomalous in reply to ASAdvocate

curious why Epstein would say that it does not affect AS

ASAdvocate profile image
ASAdvocate in reply to Anomalous

Read this article:

ncbi.nlm.nih.gov/pmc/articl...

Thank you ASAdvocate. I am wondering why this study did not separate Hazard ratios (HR). Binning cohorts by the well known adverse pathology prognostic parameters using Grade Group score, TNM, PSAD.

I think this is important because a higher Grade Group could easily skew the overall HR from PNI.

Thank you ASAdvocate. I think study reinforces the hypothesis that the well known adverse pathology prognostic parameters using Grade Group score, TNM, PSAD could easily skew the overall HR from PNI.

You may also like...