The simple answer is NO, however it should change your treatment game plan.
A member of one of my support groups who has been doing active surveillance for about 5 years recently reported that their current biopsy indicated that they now have perineural invasion (PNI). They did not understand what was the significance of this finding and they wanted to know if they now had advanced prostate cancer.
In reality, PNI is found in almost 30% of positive biopsies.
However, before I discuss the significance of this finding it is important to understand what this means. When a pathologist finds that there is PNI they are saying that they have found prostate cancer cells surrounding or tracking along a nerve fiber within the prostate. This does not mean that the cancer has left the gland.
Not withstanding this the importance of this finding , it takes on a new light when you realize that nerves within the prostate travel outside of the gland through microscopic holes in the prostate capsule. The capsule is the outer covering of the prostate gland, which for some period of time can manage to contain cancer cells within the gland. In essence it is a barrier protecting the rest of your body from prostate cancer cells.
However, the nerves do pierce the capsule and can offer an easy exit point for cancer cells from the gland to the rest of your body.
The real concern about the presence of PNI in a biopsy is it indicates that there is a higher likelihood that the prostate cancer has or will escape from the prostate gland, or become advanced prostate cancer.
There have been studies that have compared the final pathologic findings (after radical prostatectomy) to men with and men without PNI on a biopsy. These studies have shown that men with PNI have a 2-3 times higher rate of extra-capsular extension (prostate cancer outside of the gland) and nearly twice the likelihood of positive margins after prostatectomy when compared to men without PNI on their prostate biopsy.
Simply put, the presence of PNI doubles the chance of a man having T3 disease (tumors that have broken through the capsule).
The other important findings are that finding PNI on biopsy is associated with a higher Gleason grade (Gleason 8-10) or a higher grade disease even when only low grade disease (Gleason <7) is found on biopsy (possible sampling error) and that men with PNI are at a higher risk of seminal vesicle invasion and lymph node metastases.
In fact, one study demonstrated that over 40% of men with PNI and low grade disease on biopsy are subsequently found to have high grade disease on final pathology after prostatectomy.
Having PNI after a Prostatectomy has negative impact on prognosis. At Johns Hopkins there was a study that followed 1256 men with prostate cancer for an average of 3 years after radical prostatectomy. One hundred eighty eight men (188) of this population (15%) had PNI on prostate biopsy. Despite the short three year follow up period men with PNI on biopsy were found to have three times the likelihood of PSA recurrence as compared to those men without PNI. This finding has been duplicated in other studies.
What about the prognosis after radiation therapy? The story is similar; the presence of PNI on prostate biopsy has a negative implication. One study followed 381 men undergoing radiation therapy for localized prostate cancer, 86 (23%) of whom were found to have PNI on prostate biopsy. After 5 years of follow up, 69% of men without PNI were free of cancer as compared to only 47% of men with PNI.
The presence of PNI on a biopsy could instantly transform an otherwise low risk prostate cancer into a high risk disease.
Since having PNI on final pathology clearly and negatively affects prognosis its presences should influence the treatment decisions.
A study of surgical approaches in men with PNI demonstrated that removing the nerves on the side of the prostate with PNI on biopsy led to a positive margin rate of 11%. In contrast, the positive margin rate was 100% when the nerves were spared on the side of PNI.
It stands to reason that men going forward with surgery should consider not having nerve sparing surgery. In addition, given the high likelihood of positive margins and T3 disease, men with PNI on biopsy should also discuss with their doctors undergo radiation therapy following the radical prostatectomy.
Similarly, men opting for treatment with radiation with PNI should consider themselves high risk no matter what their Gleason or PSA score and opt for a combination of radiation and hormonal therapy rather than radiation therapy alone.
Perineural invasion (PNI) on biopsy is a very significant and needs to be treated as such, despite Gleason grading and PSA scores. It can indicate high risk prostate cancer, even in men with who otherwise we would consider to be low risk.
PNI is not necessarily advanced prostate cancer, but it is often associated with a poorer prognosis, leading to a higher risk of recurrent and metastatic disease.
Stone NN, Stock RG, Parikh D, et al.
J Urol. 1998;160:1722–1726.
[PubMed].
Vargas SO, Jiroutek M, Welch WR, et al.
Am J Clin Pathol. 1999;111:223–228. [PubMed].
Holmes GF, Walsh PC, Pound CR, Epstein JI.
Urology. 1999;53:752–756. [PubMed].
de la Taille A, Rubin MA, Bagiella E, et al.
J Urol. 1999;162:103–106. [PubMed].
Epstein JI, Partin AW, Sauvageot J, et al. Prediction of progression following radical prostatecotmy: a multivariate analysis of 721 men with long-term follow-up. Am J Surg Pathol. 1997;20:286–292.[PubMed]
Joel T. Nowak, M.A., M.S.W.
Hi Joel, once again a great article and information I wish I had known this (or doctors who would have told me this) when I had my biopsy. I had PNI but was told I had negative margins after surgery and did not have radiation until two years later after recurrence. Unfortunately that was too late and now I have metastatic advanced disease. I will go to my grave always wondering if I could have been cured if not for the doctors who refused to do tests and then doctors who chose not to give you all the information they may have known. I relied on the information and suggestions they provided and because I did not go that extra step and look out for myself I now find myself in this situation where I will never know if I could have been cured. I hope men who get a positive biopsy take more control of their treatment and don;t wind up like me.Good job, Joel
Ron,
I understand your feelings, they are legitimate. However, one thing that I have learned is that there is no reason to look back, what has transpired has happened and there is nothing we can do to change the situation. What we can and must do is learn from our errors so that we don’t repeat them again and try and teach from our experiences so that another man will not fall into the same trap. – Joel
Great article that answered my nagging doubts concerning pni. I had been told not to worry thst I had pni in my pathology. As pt2n0m0 and g6 I was confident its all gone. Wil take care now to be monitored each year. Lots of people still say to ignore pni which adds to confusion.
This article was very informative and clear about the definition of PNI. My husband has just been diagnosed with Stage II, t2c with PNI in 5 of the biopsies. He will have an MRI & bone scan within the next day or two to find out if it has spread. The waiting and not knowing is difficult. When you know, you can focus and plan for what is coming.
When a pathology reports indicated that there is perineural invasion this means that cancer cells were seen surrounding or tracking along a nerve fiber within the prostate. The nerve fiber goes through an open area which MIGHT allow for easier spread of the cancer outside the gland. This means that you are at an increased risk for a spread, but it doesn’t mean that it has spread.
You should have a very careful discussion with your doctor as you are at an increased risk of having a recurrence. You should explore with the doctor the possible risks and rewards of additional treatment (radiation) or in the alternative, beginning a very aggressive surveillance program to make sure that your PSA becomes and stays unmeasurable.
Radiation is not free as it always comes with side effects. I don’t like it when it is described as a non-invasive treatment modality.
Joel
Very good article. Thx. I am 52 years old and had Radical Prostectomy on 3/23/15. The Surgical Pathology Report listed “Present” for Perineral Invasion. Do I anything to worry about or need Radiation? My gleason as 3+4, 7.
Thanks,
Tim
Thanks Joel. I spoke with my Urologist and he kinda blew if off and just said we would check my PSA again in 90-days. In addition, I contacted my surgeon and he agreed that waiting another 90-days to re-check my PSA levels. (My Urologist and Surgeon are two different doctors in two different cities), However my Urologist did start the conversation with “other doctors may want you to do Radiation, but let’s wait”. Should I insist on the radiation or take the doctors advice to wait. The waiting gets to you and I find myself thinking about it often and researching more an more things on the web, which is very extensive. Surgical Pathology report also stated “Focal extraprostatic extension into the anterior bladder neck”. The surgeon underlined it and circled it, but really don’t know what is means. By the way, Gleason grad 3+4=7 with focal extraprostatic extension ino teh bladder neck; Pathologic statging pT3a pNX. Lots of stuff that I do not know what to do. Thx. Tim
Joel,
I will send you a PDF of the Surgical Pathology Report if you want to provide an email address and you believe it might be beneficial/informative to you assisting me. Thanks,
Tim
Hi, I had 3 PSA tests, each approx 3months apart, 4.8 (5/15), 4.4 (9/15) and the latest 4.3 (12/15). My biopsy showed 2/5 malignant on the LHS, with 5% malignant with largest length 2mm and no PNI or extraprostatic spread. But the RHS has 4/5 malignant with70% malignant with largest length 11mm and PNI invasion, however, again no extraprostatic spread. My Gleason is 3+4=7. and I’ve been told I’m between T2 and T3, no real a, b or c stated though.
I was only diagnosed and confirmed by the biopsy in August 2015. I want active survelliance to at least get some idea of rate of growth before I do anything urgently, and later feel that surgery for a prostraectomy, possibly the radiation late to hopefully stop/prevent reoccurance.
However, the doctors don’t tell you much and are always in a rush to see the next patient, but without telling me in the detail I wish to know, they want to do 3months of hormonal therapy immediately, followed by 7 weeks of radiation. What is your advice as to what I should do now?
Keith,
The very first thing you should do is have a second opinion on your biopsy slides. To learn how to do this go to the Malecare web site, specifically to:
http://malecare.org/second-opinion-on-biopsy-slides/
Then go back to the Malecare main page (www.malecare.org) and click through and read all the information, paying special attention to the section called “newly diagnosed.” There is a wealth of information you need to have prior to making any treatment decisions.
Joel
My father Gleason is 5+4 = 9/10 Can you tell me how far the cancer spread
Thank you
Ronelle,
A Gleason score can not teel how far, or even if the cancer has left the gland and spread. The Gleason score is a measure of the aggressiveness of the cancer. A Gleason 9 score like your fathers is a sign that the cancer is very aggressive and can not be ignored. I suggest that he send the biopsy material to a second lab for another opinion and that he begin learning about the cancer and his treatment options. With a Gleason 9 he needs to do this expeditiously so if it hasn’t yet left the gland it may be treated before it leaves.
– Joel
I underwent radical robotic prostatectomy on 12/2/16. My surgical pathology conclusion report indicates:
1. The sections of prostrate show moderately differentiated adenocarcinoma of predominant Gleason pattern 4 and foci of Gleason pattern 4. The tumor involves both sides of prostrate. Overall, the tumor involves approximately 80% of the gland. PIN is present in the surrounding tissue. Perineural spread is present. The tumor extends beyond capsule into adjacent connective tissue. Both seminal vesicles are involved by the tumor. The tumor is present at the circumferential resection margin. It is present in resection margin of both vas deference as highlighted by CK. The tumor is also present at the apex and base. Separate tissue shows fiboadipose tissue and vas deference involved by tumor.
2. Sections show three polypoidal pieces of skin with features of fibroepithelial polyp. There is no evidence of malignancy.
Please what does this mean, and what treatment options should be adopted. Thanks.
Henry,
This means that you have a lot of aggressive prostate cancer in your gland and also outside of the gland in the surrounding tissue. You are in need of treatment and should have it much sooner than later. Treatment can include surgery, radiation and hormone therapy. Get a second opinion on the biopsy slides to confirm the information you were supplied and seek the opinion of a medical oncologist who specializes in the treatment of advanced prostate cancer.
Joel
Thank you for the write up on this. I was recently diagnosed with prostate cancer in 2 of 12 nodes with a Gleason score of 3+4 = 7. 50% in one and 60% in the other. PSA = 3.207 and PSA, free of 15. PNI was identified in the right lateral apex. In considering my treatment options I have been considering HDR Brachytherapy from one of the leading centers for that treatment and robotic surgery again from one of the top surgeons. Would presence of PNI suggest one over the other?
Joel
Sorry, that should be 4+3=7 on the Gleason. I know that is a big difference.
A finding of PNI on a needle biopsy probably increases the changes of there being an extraprostatic extension and an increased risk for a recurrence. However, there is no evidence I am aware of that shows a better result between primary surgery or radiation as long as the cancer is still contained in the gland.
Joel
I am 75 years old, I am Turkish, living in Ankara,Turkey. Lately my My PSA level varied between 4.2- 6.08. I had biopsy My prostate biopsy report writes ‘Gleason grade 3+4=7 medium diferansiyel, perinoral invasion detected’. First I was given two options a) surgical, b) radiotherapy First of all I wanted to have surgery but later on I have been advised to have hormonal treatment (3 injections in the abdomen ) one in every 3 months plus radiotherapy (37 days, 12 minutes each day). Could I please have your comment on my case
Yours,
Tando?an Engin
You did not share how much cancer was in each positive biopsy and how many had any positive cells. What about your general health?
Joel
Gleason 3+4=7 after rp 4+3=7 psa 12, one lymp node out of 12 postive with no extranodal extension???? In the Pathology report everything was great except perineural invasion is seen ??????? psa now undectable after 4 months Iam 64 My prostate was 12% cancer ty scott
Great share Joel; I was first diagnosed with prostate cancer in 2008. Without going into the long explanation as to why I decided to wait to decide on a treatment, I chose to have surgery in 2012. I watch my psa go from 3.80 in 2008 to 9.12 in 2012. I went from no PNI in 2008 to one area identified with PNI in 2012. The test showed,
” A. PROSTATE, RIGHT APEX, NEEDLE BIOPSY: ADENOCARCINOMA OF THE PROSTATE, GLEASON SCORE 3+3=6. CARCINOMA INVOLVES ONE OF TWO NEEDLE BIOPSIES AND ACCOUNTS FOR APPROXIMATELY 75 PERCENT OF THE TOTAL SUBMITTED TISSUE. FOCAL PERINEURAL INVASION IS IDENTIFIED.”
Presently, PSA is undectable at <0.01 ng/mL. But I would like to know, are there some questions I need to ask concerning the PNI? Are there additional test that should be done at this point? Sometimes it is a matter of knowing what to ask.
Hi Joel,
My father has been diagnosed with Prostate cancer in December 2016. We are in London,UK and the National Health Service are super slow. He has a gleason score of 4+3 with peri neural Invasion, small volume disease. PSA 4.9, MRI prostate likert 4 and left inguinal lymph nodes. no performance status. The Dr has explained there are complications of radical radiotherapy and radical prostatectomy. What treatment would you reccommend? My dad is 53. generally fit and healthy but a smoker. Do you know if he will be cured and still have a normal life expectancy?
Thank you.
Mya
Hi
My father underwent robotic surery on 11th August. The final hisptopathology report mentions pT3aN0MX
– Tumor involves 55% of the volume in both lobes
– Lymphatic tumour emboli and perineural invasion is seen
– Adjacent prostate shows focal low grade PIN
– Seminacal vesicals are free of tumour
– Lymph nodes free of tumour
– periprostatic fat free of tumour
– Bladder and urethal ends free of tumour
Can you please explain what this means? will he still need to undergo radiation or ADT?
Just to add Gleason score in histopathology report is 4+4 = 8. PSA count before surgery was 10.4
Was there an answer to Tim Tornado? I have the same post surgery prognosis. Getting first psa next week. pT3a Extraprostatic extensions into the bladder neck. What does this mean to me?
Newly diagnosed PSA 20
Turp biopsy
Left prostate gland, ,core needle biopsy
Prostatic adenocarcinoma, Gleason grade 3+3 (6) 40% of the total tissue
Negative for perineural invasion
Right prostate
Prostatic adenocarcinoma, Gleason grade 3+3 (6) 10% of the total tissue
Positive for perineural invasion
Prostate gland, transurethral resection
Negative for prostatic adenocarcinoma
Benign Prostatic hyperplasia
Rare fragments of dysplastic epithelium (either urothelial or squamous
SO….what should do next…….Im worried
Hi Blaise
I totally empathize with your feeling of worry. And, I can tell you that your worry will dissipate with time. From what you write, you are in a good place, cancer wise. Most doctors seeing your history would suggest active surveillance, where you continue to enjoy your life while monitoring your PSA and free PSA with quarterly or try-annual blood tests. You should ask your doctor if the Tarp Biopsy was sufficient for a proper diagnosis. Perhaps, a 3TMultipara MRI guided biopsy would be useful, as well as genetic testing of the tissue that was harvested with your Turp. Also, join the prostate cancer communities at healthunlocked.com where you can pick the brains of thousands of very smart prostate cancer patients.
Hi John You should join the advanced prostate cancer community at healthunlocked and ask the guys there….they are very smart and experienced. https://healthunlocked.com/advanced-prostate-cancer
Hi ,
My dad is 63 , during the regular health check we got to know his prostate is enlarged and doctor advices us to go for biopsy. After the biopsy the readings came has 3+4=7 . The doctor advices us to go for surgery and he did open surgery to remove the prostrate and the specimen was sent for biopsy again for further test. The report says extaprostatic extension not seen and no lymphovascular invasion is seen and margins are free from Tumor and right side base along with perineural invasion. Doctor told me that the tumor is not spread but chances of spreading via nerve may be positive but not to worry at the moment and to do PSA for every three months to check if it’s spreading. I am not sure do I need to worry . Can u please guide me what should I do.
Sounds like you have a wise doctor. Your father is offered good advice.
My dad was recently diagnosed with prostate cancer 11/7/2017. He was initially referred to a urologist when his yearly PSA jumped from 5 to 12. Upon initial consult with his urologist, he was told to take another PSA a month after the first one. The second one was 14. He was then advised to undergo a biopsy which was done. He is a Gleason 7 (3+4). 4/6 cores were positive for Adenocarcinoma, only the left and right apex of the gland were spared from cancer cells. The biopsy report further showed a maximum size of the carcinoma to be 0.5 cm. Percent of overall tissue involved by carcinoma: right- <5%, left- 5-10%. Highest Gleason score at a single site was 7 (4+3). Percent of Gleason grade 4 and/or 5 is 30-40%. Extraprostatic or seminal vesicle invasion is not identified. Perineural invasion is present. Lymph-vascular invasion is not identified. High grade prostatic intraepthelial neoplasia is not identified. He was given the option for radial prostatectomy via robotic surgery or radiation/ brachytherapy alone. My father opted for the former. He was also give a Lupron shot to suppress testosterone since he expressed his desire to go back to his home country to fix whatever he needs to fix there and come back for the surgery January of next year. I was just reading his biopsy report and stumbled on PNI being present. He was also told by the urologist that after the surgery, his PSA levels will be monitored. Should I ask him again if radiation is still needed post surgery? My father expressed adamantly that he didn't want any radiation therapy. That's the reason why my dad agreed on doing the surgery. Any information would be very helpful. Thank you!
Sounds like your Dad knows what he wants and what he doesn’t want. I think you should respect your Dad’s wishes.
I read most of these QnA it’s amazing the infos you were giving some are very indicative of wrong advises. First of all anything with beyond 4+4 =8 you should not consider anymore treatment instead just go with hormonal therapy since this will help more and be comfortable instead of any type of surgery for his cancer is already out and no longer contained. The best chance you can advise are only for those with 3+4=7 has a better chance of recovery and less to worry cancer will occur. On the other hand I still believed cancer is cancer and there’s no cure the treatments only lingers your life span. At this time the best treatment so far effective and less invasive is the modern Proton that’s been out in the market done at University of Florida or in La Jolla California or other places like JHUH. The rest are all prayers and eat healthy especially those in the last stage that they can linger their lives by eating healthy without meat intake no sodas ,no sweets, carbs, and dairy products intake Eat more fresh vegetables fresh smoothies of dark fruits. My husband was diagnosed since 2006 with 3+3-6 and had PNI only in 2009 with Gleason reading still of 3+3=6 and never had biopsy till 12/2017. His latest biopsy still with PNI with incresse of Gleason 3+4-7. which is still less agressive. I was able to do aggressive watchful waiting with eating healthy with above infos I mentioned. But with this latest biopsy we’re thinking time for treatment due to his age. I don’t believed younger years he should have those available conventional treatments. With this latest technology MRI Biopsy n Proton I am convinced it’s time for treatment. I believed that once the cancer invaded treatments are no longer an option that’s my great n best opinion. The thing that amazed me how much my alternative approached helped him by eating healthy. And even if Proton will be done in him I will still continue the alternative way I am doing with my husband fresh juicing of vegetables and adding powdered greens less headaches buying fresh leafy vegetables n gets spoiled easily. I do fresh juicing that I I added the greens consist of Celery, Carrot, Ginger and Beets plus added Apple Cider Vinegar n powdered Cucurmin and Turmeric.. Also over the years I added ANGIOSTOP n MYOMIN which I think that really helped him over 11 years. It’s a proven fact that over the years his cancer contained n never spread out as ii have mentioned he had PNI since 2009. But I am pretty sure his age has a big factor if why his PSA is going up. To all who can read my comments please take an extra efforts to read about your condition. Never trust your doctor be an advocate to your own self. Dr never explained fully your problems and they are just good in cutting you or do radiation or etc. because once it’s done they washed their hands. Lastly DIETS is a big factor and help whatever health issue or condition you are in or may have so eat right. Do extra prayers
Thank you and God bless you.
Sir my father please
Prostate chip’s
An acinar adenocarcinoma of prostate gland
Tumour volume 40
Gleason score 3+4=7
Perineural invasion present
Isup prognostic grade group _group 2
My husband ultimately opted for radical prostatectomy surgery- “just cut it out” – after considering radiation or active surveillance ( as an Agent Orange exposed Vietnam Veteran which is sometimes indicative of more aggressive PC, didn’t embrace that course) , – and had it robotic assisted lap method 2 weeks ago. Good new in verbal from Dr 4 days post op was that “margins clear, negative for cancer in dissected lymph nodes” I recently got my hands on printed Path report and note that Gleason score of 3 +3 / Grade Grp 3 ( vs biopsy 4+3) , tumor only in 5%-Pt2 organ confined , Extraprostatic Extension/ Urinary Neck Invasion/Seminal Vessel Invasion<- all these negative/not identified- All of which which seems very favorable. Only thing that alarms me is mention of "Perineural invasion present". Need I be concerned about this? At this point other than recovering from surgery only follow up scheduled so far is PSA in 3-4 months.
I have had radiation & 43 seed implants in 2013. My psa score went down but never went to zero. I had psa checked every 6 months until last year. My psa score had been steadily increasing & now it is at 14.69. I had my last lab work done in October of last year & it was 7.45 at that time. The pathology report stated there was PIN present before radiation. I am set to go for a CT scan of the abdomen, pelvic & hip in a week or two. My doctor wants to see what shows up.
Do I need to be very concerned? My Gleason score was 6 & my Urologist said I have non- aggressive cancer.
Looking forward to hearing your opinion.
Dear sir,
Here are my prostate #’s.
Left base: gleason score 6 (patterns 3+ 3) grade group 1. Tumor involves 1 tissue core over a 2mm linear segment ( about 10% of sampled tissue. Perineural invasion: not identified.
Left mid: gleason score 7 (80% pattern 4 + 20% pattern 3), grade group3. Tumor involves 1 tissue core over an 11mm linear segment about 50% of sampled tissue. Perineural invasion: not identified.
Left apex: gleason score 7 (80% pattern 4 + 20% pattern 3) grade group 3. Tumor involves 2 tissue cores over an aggregate 1mm linear segment about 5% of sampled tissue. Perineural invasion: not identified.
Right base: gleason score 7 (70% pattern 4 + 3-% pattern 3), grade group 3. Tumor involves 2 tissue cores over an aggregate 1.5mm linear segment about 5% of sampled tissue. Perineural invasion: not identified.
Right mid: gleason score 7 (70% pattern 4 + 30% pattern 3). grade group 3. Tumor involves 1 tissue core over an aggregate 4mm linear segment about 15% of sampled tissue. Perineural invasion: not identified.
Right apex: gleason score 7 (80% pattern 3 + 20% pattern 4), grade group 2. Tumor involves 2 tissue cores over an aggregate 4mm linear segment about 15% of sampled tissue. Perineural invasion: not identified.
The doctor recommends robotic assisted radical prostatectomy? What are your thoughts?
From my book, surviving prostate cancer by Dr Patrick Walsh’s
This article come from my book, surviving prostate cancer:
What About Perineural Invasion?
As cancers grow, they compress normal tissue, looking for elbow room—spaces with less resistance, where they can spread. It just so happens that nerves are usually surrounded by some empty space. For cancer, this is the real estate equivalent of a nice suburban lot with a big backyard—plenty of elbow room. Thus, it’s not uncommon to find prostate cancer in the spaces around the nerves; this is called perineural invasion. Because the nerves are most common close to the surface of the prostate, the finding of perineural invasion on a biopsy suggests that the cancer is close to the edge of the prostate and may well have penetrated the capsule.
However—this is important to keep in mind—cancer that has penetrated the capsule can still be cured. This makes perineural invasion a paradoxical finding, because although men with perineural invasion are more likely to have capsular penetration, they may still be cured with local treatment (surgery or external-beam radiation therapy) alone.
It was previously thought that nerve-sparing surgery should not be performed on the same side as the perineural invasion. However, this has turned out not to be an issue because of a fine distinction: the tumor is surrounding the nerves to the prostate, not the nerves responsible for erections. Johns Hopkins urologist Stacy Loeb recently studied men with perineural invasion who underwent a radical prostatectomy at Hopkins, and her findings show good news. Although these men had more aggressive cancer, the presence of perineural invasion by itself was not a predictor that their cancer would come back, and the nerve-sparing procedure had no effect on their risk of developing rising PSA after surgery. However, another study from Hopkins on men who received radiation showed that men with perineural invasion on their biopsy had a higher chance of PSA failure (an increase in PSA levels following surgery or radiation, indicating that the cancer may have returned) and prostate cancer–related death. Similar results have been confirmed by other groups.
For this reason, at Hopkins, men with perineural invasion on their prostate cancer biopsies who choose radiation therapy typically receive treatments that include the addition of hormones and increased radiation dosages to the prostate.
A recent biopsy after a PSA test of 3.5 showed Adenocarcinoma in 1 of 14 samples. Gleason score of 6 (3+3). tumor in 10% of core sample of the prostate transition zone. Perineural invasion present. Can I use active surveillance or does the presence of PNI eliminate that option.