Suspicion of Perineural Invasion

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User

Posted 05 May 2025 at 15:22

Just been diagnosed last week and everything is a bit of a blur and still in a bit of shock. I've had MRI and Biopsy. Was looking for any advice from the community on experience with "Suspicion of Perineural Invasion" Thanks

TEST RESULTS

PSA LEVEL AT DIAGNOSIS: 7.2

GLEASON SCORE &GRADE GROUP: GRADE 1 GLEASON 3+3=6

CAMBRIDGE PROGNOSTIC GROUP (CPG): CPG1

T STAGE AT DIAGNOSIS (if known): T2c

N STAGE AT DIAGNOSIS (if known): Nx

M STAGE AT DIAGNOSIS (if known): Mx

MY CANCER IS : LOCALISED (CONTAINED INSIDE PROSTATE)

TREATMENT PLAN: ACTIVE SURVEILLANCE (BUT YOU HAVE SUSPICION OF "PNI") (vs) SURGERY (vs) RADIOTHERAPY.

I have further appointments with Urologist and Specialist Nurse in next few weeks.

User

Posted 05 May 2025 at 16:01

Hi Brian.

I'm sorry that you you've had to find us, but welcome to the forum, mate. You'll find a lot of support here.

Most if us have felt gutted when diagnosed, but dealing with PCa is like dealing with any setback in life. You've got to get on with it. 🙂

Your Gleason score is low and it appears the disease is prostate confined. Your PSA is elevated but not drastically so.

Two years ago, I was in a very similar position to you. Please read my profile history.

I elected active surveillance, which unfortunately failed for me. However, I still don't really regret my decision. My only concern would be your T2c staging, the PNI wouldn't really bother me that much.

Probably knowing what I know now, I'd still have taken active surveillance, but I'd make sure the surveillance was active.

I started a conversation on T2c disease and active surveillance, it maybe of interest to you.

https://community.prostatecanceruk.org/posts/t29997-T2c-disease-and-active-surveillance.

Whatever you decide please keep us updated and I wish you the best of luck. 👍

User

Posted 05 May 2025 at 17:00

Perineural Invasion means the cancer was found to be tracking along inside nerve sheaths inside the prostate. That slightly increases the chance that it could have tracked outside the prostate via nerves from the prostate bed, but this is only a very slight increase in risk, and some oncologists suggest none at all. If you are weighing up treatments, it's a very minor factor in favour of external beam radiotherapy, as that will spill into the prostate bed too hopefully mopping up any spread into it, but again not a big factor because the extra risk is small. It's also a small factor against Active Surveillance, because it's a slightly higher risk than if it wasn't there, hence why they have caveted the Active Surveillance with this warning.

These are not the erection nerves, and it doesn't say anything about the prospects of nerve sparing or not.

User

Posted 05 May 2025 at 18:28

My diagnosis included PNI, but I was T3 G9 so treatment was needed and RT made sense in my case. Everything about your diagnosis is low risk, but I guess T2c is not that far from becoming T3a.

The latest treatment for disease at your stage is SABR, five high doses of RT over a total period of about two weeks. It is not yet offered in all NHS trusts. It is as effective as any other treatment, and has minimal side effects, compared to the old regime of 20 RT sessions over a month and two years of HT. It is not appropriate for high risk disease (which yours is not).

If SABR is offered I would jump at it. If not I would consider 6 months of active surveillance mainly with the objective of delaying your treatment until your NHS trust can offer SABR. If the active surveillance is still OK after six months consider staying on AS but be ready to get treatment pretty soon, because once it is T3 the treatment becomes a bit tougher.

Dave

User

Posted 05 May 2025 at 19:25

My understanding is T2C does not mean it is close to being T3A. What it does mean is that there is malignancy in both sides of prostate. This could mean it is more extensive than T2A but that is not a given because you could have one large lesion on one side of the prostate ie T2A that when you have surgery is found to have broken through or is bulging the prostate wall making you T3A. Conversely you could be T2C and the cancer is very well confined. Not too long ago T2C was thought to be “high” risk in terms of AS but more recent research has suggested this is not the case. Indeed pathologists are no longer under any requirement to specify T2A, T2B or T2C and only have to specify T2. Your Gleason score is 3:3 which is very good news. Speak to the professionals involved in your care because I am sure you have been told in your circs there is no need to rush into anything.

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