This forum is for the discussion of anything to do with Prostate Cancer. There are only four rules:
No fundraisers, no commercials (although it is OK to recommend choices of treatment or medical people based on your personal research; invitations to participate in third-party surveys are also acceptable, provided there is no compensation to YANA);
No harvesting e-mail addresses for Spam;
No insults or flaming - be polite and respectful at all times and understand that there may be a variety of points of view, all of which may have some validity;
Opinions are OK, but please provide as much factual evidence as possible for any assertions that you are making
Failure to abide by these simple rules will result in the immediate and permanent suspension of your posting privileges.
Since this is an International Forum, please specify your location in your post.
As I understand it, perineural invasion (PNI) is when cancer has started to invade the nerves in the prostate. This would eventually lead to a pathway to the outside of the capsule.
However it is viewed differently when discovered during biopsy than it is when discovered post operatively.
If discovered during biopsy investigations it can raise the suspicion that there may possibly be extra capsular penetration.(Since it could provide a good path to the outside). But if it is found after an operation and contained within the removed prostate and there is no extra capsular spread, it is not regarded as significant.
I am obviously not a doctor, but as I understand PNI, it is found so often in the pathology AFTER prostate removal that many pathologists no longer even note it. PNI discovered before surgery at biopsy is potentially far different to PNI found after surgery.
Re: Re: Re: not sure what is meant by perineural invasion
I was reading a book this morning by Sheldon Marks,MD called Prostate and Cancer (third edition) and the question was asked in there on page 83 "What does perineural invasion on the biopsy mean?" and his answer is " Perineural invasion means that the cancer is showing signs of more aggressiveness. It is not invasion of the nerves that cause erections."
I am not sure that Nettie has correctly understood the issue here with PNI. I am not familiar with Doctor Marks or the context of the quote from him. But what is not made clear in the quote is whether he is talking about PNI in the biopsy that preceded diagnosis OR the pathology AFTER surgery.
As I said in my earlier post, PNI at the diagnostic biopsy rings an alarm bell because it could, possibly, maybe, indicate that the cancer has spread to the outside of the prostate capsule or that it is moving in that direction.
This is completely different to finding PNI when the prostate is removed, because then, at THAT point, the pathologist can see as a matter of FACT if there is any spread outside.
So, if on prostatectomy, the excised gland has clear margins and no extra capsular penetration, the PNI which may have been discovered at biopsy will not be regarded as having any significance. Which is why many pathologists do not even bother to report it when found in those conditions after surgical removal of the gland.
