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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.
