Prostate Cancer Survivors






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Re: post surgery pathology report - Advice please

Dear Nettie

Thank you very much for your response. It is strange that my report is similar to your husbands. My doctor is away on holidays. On verbal conversation he did not mention this. Only when I read the report, it mentioned about PNI.I looked back at the forum per your advice but not really in a state of mind to comprehend and evaluate the posts and the responses, do not quite understand whether it means spread of cancer later through the nerves. What is your opinion ?

Many Thanks

Re: Re: post surgery pathology report - Advice please

G'day John,

I'm not sure what your concern would be if you have read through the previous thread on this subject. The best of the responses inclucded the piece by Bill Hennings, well known in the PCa Internet world, which i have clipped and pasted below. Note his conclusion

Men who encounter Perineural Invasion in their Biopsy Reports should not be concerned at all.


This was written by Bill Hennings. Bill has been the idea and main push behind the Prostate-Help Chats. He has been fighting cancer for a number of years and knows this disease well. We thank him for this contribution.

The Pathologist that examines the tissue from a biopsy of the Prostate Gland will often state that Perineural Invasion can be seen. This finding sounds ominous to most laymen and causes them to be concerned that their Prostate Cancer is more serious then indicated by the usual Gleason Score, PSA and Staging information. Especially in these days of 10-12 biopsy specimens, Perineural Invasion appears to be more common.

What is Perineural Invasion? The Prostate Gland is not a homogenous organ. It is made of many glands, ducts muscles and nerves. The glands manufacture the seminal fluid, the ducts transport and store the fluid. Muscles expel the fluid during ejaculation and the nerves carry the signals that choreograph the whole process. The nerves are in sheaths and not attached to the other structures except at their end points.

When the Prostate Cancer tumor begins to grow inside the Prostate Gland it often seeks the path of least resistance and fills the void along the nerve sheaths. The tumor can be near the nerves or eventually envelope the nerve and grow along the sheaths. We then have Perineural Invasion. When the needle biopsy pierces the gland and tumor it will often pick up a piece of nerve enveloped by the cancer and the Pathologist reports he has seen Perineural Invasion in the specimen.

It has always appeared intuitive that if the cancer is growing along the nerves and the nerves enter the Prostate Capsule, a path for the cancer to leave the capsule along the nerves is available. In fact, many Doctors, including some prominent ones, have speculated that having Perineural Invasion would lead to significant extra capsular extension of the Prostate Cancer .and a poor prognosis for a local cure.

What do Recent Studies Indicate? A review of the literature concerning Perineural Invasion resulted in a few prominent studies.

1. Journal of Urology 2004 Dec;172(6Pt 1):2249-51
Perineural Invasion in Radical Prostatectomy Specimens Lack Prognostic Significance
Ng JC, Koch MO, Daggy JK, Chang L Department of Urology, Indiana University School of Medicine
CONCLUSIONS: While Perineural invasion of the radical prostatectomy specimen significantly correlated with multiple adverse pathological factors, it did not predict which patients will have early PSA recurrence following a radical prostatectomy.
PMID: 15538241

2. Int J Radiat Oncol Biol Phys. 2004 Sep 1;60(1)24-9
Association of Per Cent Positive Prostate Biopsies and Perineural Invasion with Biochemical Outcome after External Beam Radiotherapy for Localized Prostate Cancer Wong WW, Schild SE, Vora SA, Halyard MY Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona CONCLUSIONS: PNI was not significant for bNED in multivariate analysis.
PMID: 15337536
3. Am J Surg Pathol 2004 Jul28(7)946-52
Prostate Needle Biopsy Reporting: How are the Surgical Members of The Society of Urologic Oncology using Pathology Reports to Guide Treatment of Prostate Cancer Patients? CONCLUSIONS: PNI was not considered important by the majority of respondents.
PMID 15223967
4. Am J Surg Pathol 1997 Dec;21(12):1496-500
Prediction of Extraprostatic Extension of Prostate Cancer Based on Needle Biopsy finding: Perineural Invasion Lacks Significance on Multivariate Analysis
Egan AJ, Bostwick DG Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota CONCLUSIONS: We conclude that the finding of Perineural Invasion in needle biopsy of prostate carcinoma has no independent predictive value for the presence of extraprostatic extension, seminal vesicle involvement or pathologic stage in the radical prostatectomy. Accordingly, we no longer routinely evaluate this finding in biopsy specimens.
PMID: 9414194
5. J Urology Volume 59, Issue 1, Pages 85-90 (January 2002) Influence of Biopsy Perineural Invasion on Long Term Biochemical Disease Free Survival after Radical Prostatectomy
Kiaran J. O’Malley, Charles R. Pound, Patrick C. Walsh. Jonathan I. Epstien and Alan W. Partin James Brady Urological Institute, Johns Hopkins University
CONCLUSIONS: We were unable to show that PNI on needle biopsy influences long term tumor free survival.


Perineural Invasion is fairly common and plays a very minor role or no role at all in predicting long term survival of localized Prostate Cancer treatment. While you can still find some studies and Doctors that believe that Perineural Invasion is a significant finding, I believe that the cited studies from our most prestigious peer reviewed Journals refute that concern. According to reference 4 from the Mayo Clinic, they pay no attention to it at all. The reported parameters of Gleason Score, PSA, Pathologic Stage, number of positive samples and the amount of cancer in each sample are much more important then Perineural Invasion.. Men who encounter Perineural Invasion in their Biopsy Reports should not be concerned at all.

Re: post surgery pathology report - perineural invasion

My experience is that PNI is also a finding that comes with the post surgery pathology report. My own (local) urologist was clearly concerned about this finding in regards to the possible future course of my cancer. In my case there was already documented some extra prostatic invasion (stage t3a) so adjuvant radiation was to be recommended. I then asked the appropriate person at the hospital where the surgery took place if I should consider the PNI in my future actions. He indicated exactly what you read in the prior comments in this thread. He said that the going consensus was that PNI was of little or no prognostic value.