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Another question about PNI

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User
Posted 09 Dec 2019 at 08:03

After reading a recent post from another member Bean regarding PNI, i'm still confused about it.  In my husbands pathology report it states there was evidence of PNI, does this mean he has a greater chance of recurrence?  Why is it looked upon differently depending on when it's found?  My husbands nerves were saved but now I'm thinking should they have taken them to lessen the risk of the cancer returning?


We're a day off the anniversary of prostatectomy, just had another <0.05 PSA result, so relieved and very grateful.


 


Thanks for any info.

User
Posted 11 Dec 2019 at 07:41

I had surgery the first of June 2017. Had also PNI. now 30 months after surgery my PSA is still< 0.01


 


 

User
Posted 09 Dec 2019 at 09:36

I’m certainly no expert but looking at your bio the PNI was present inside the prostate and not external to it which sounds more positive to me. I’d read somewhere that the majority of patients who’ve had RP will have PNI. 
I did note that the MRI showed the cancer close to the edge but they managed to preserve the nerve bundles. I must have been similar as I was was upgraded to T3a post RP. I have since wondered why they didn’t remove the nerve bundles near the side where the cancer was. 
Anyway you are in a great position at the moment. I think you should celebrate your first year after RP and focus on the continuing positive PSA result


Have a great Christmas 


Bri

Edited by member 09 Dec 2019 at 09:37  | Reason: Not specified

User
Posted 09 Dec 2019 at 09:51

Mrs L,


I just added a clarification to my post in the other thread, as it didn't say quite what I meant. PNI doesn't necessarily mean no nerve sparing. It does very slightly reduce the success rate of RP, but not due to nerve sparing. (I think it might be because it sometimes suggests there might be some more aggressive cancer than found at diagnosis, but you would know if that was the case from the subsequent histology if it resulted in the Gleason score being increased.)

User
Posted 10 Dec 2019 at 07:54

Thanks for the information Bri and Andy. Husband saw the consultant yesterday and also asked about this, he said they don't use PNI as a marker anymore, of course husband didn't ask him to elaborate 😒, but he did say that we've had a good outcome, so once again I'm very grateful.  I can't believe it was a year ago today that we were in the middle of dread and uncertainty. My thoughts are with everyone that is going through this disease, I realise some have it easier than others and I'm praying we stay on the easy side 😐.


 


Merry Christmas to you, wishing us all a worry free new year.


x

User
Posted 11 Dec 2019 at 11:27
PNI identified post-op is apparently so common that it hardly seems significant - the old thinking was that it indicated a higher risk of recurrence. PNI identified at biopsy is less usual and needs some consideration as it may be that there is more cancer than the other cores suggest. But again, the introduction of mpMRI means that cores taken are more targeted than in the past so a sample that shows PNI can be triangulated with the detailed analysis of the scans, etc., before treatment options are recommended.

John was diagnosed as T1 but with PNI and the surgeon's view was that there was a 55% chance of recurrence post-op. Once the prostate was in a petrie dish, the PNI turned out to be a reliable indicator as the cancer was much more extensive than predicted and he was upgraded to T3. He also had a recurrence and needed salvage RT/HT. But that was all before mpMRI was introduced.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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User
Posted 09 Dec 2019 at 09:36

I’m certainly no expert but looking at your bio the PNI was present inside the prostate and not external to it which sounds more positive to me. I’d read somewhere that the majority of patients who’ve had RP will have PNI. 
I did note that the MRI showed the cancer close to the edge but they managed to preserve the nerve bundles. I must have been similar as I was was upgraded to T3a post RP. I have since wondered why they didn’t remove the nerve bundles near the side where the cancer was. 
Anyway you are in a great position at the moment. I think you should celebrate your first year after RP and focus on the continuing positive PSA result


Have a great Christmas 


Bri

Edited by member 09 Dec 2019 at 09:37  | Reason: Not specified

User
Posted 09 Dec 2019 at 09:51

Mrs L,


I just added a clarification to my post in the other thread, as it didn't say quite what I meant. PNI doesn't necessarily mean no nerve sparing. It does very slightly reduce the success rate of RP, but not due to nerve sparing. (I think it might be because it sometimes suggests there might be some more aggressive cancer than found at diagnosis, but you would know if that was the case from the subsequent histology if it resulted in the Gleason score being increased.)

User
Posted 10 Dec 2019 at 07:54

Thanks for the information Bri and Andy. Husband saw the consultant yesterday and also asked about this, he said they don't use PNI as a marker anymore, of course husband didn't ask him to elaborate 😒, but he did say that we've had a good outcome, so once again I'm very grateful.  I can't believe it was a year ago today that we were in the middle of dread and uncertainty. My thoughts are with everyone that is going through this disease, I realise some have it easier than others and I'm praying we stay on the easy side 😐.


 


Merry Christmas to you, wishing us all a worry free new year.


x

User
Posted 11 Dec 2019 at 07:41

I had surgery the first of June 2017. Had also PNI. now 30 months after surgery my PSA is still< 0.01


 


 

User
Posted 11 Dec 2019 at 11:27
PNI identified post-op is apparently so common that it hardly seems significant - the old thinking was that it indicated a higher risk of recurrence. PNI identified at biopsy is less usual and needs some consideration as it may be that there is more cancer than the other cores suggest. But again, the introduction of mpMRI means that cores taken are more targeted than in the past so a sample that shows PNI can be triangulated with the detailed analysis of the scans, etc., before treatment options are recommended.

John was diagnosed as T1 but with PNI and the surgeon's view was that there was a 55% chance of recurrence post-op. Once the prostate was in a petrie dish, the PNI turned out to be a reliable indicator as the cancer was much more extensive than predicted and he was upgraded to T3. He also had a recurrence and needed salvage RT/HT. But that was all before mpMRI was introduced.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
 
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