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Perineural invasion with Gleason 6 - should I be concernerd?

User
Posted 07 May 2025 at 14:20

I have just received the full report from my MRI and Biopsy and the mention of Perineural Invasion being present raises alarm bells, and maybe re-questions the previous decision for active surveillance?

 

The diagnosis is:

PSA 4.8 last October, 5.6 in November, 6.6 in Feb at time of Biopsy, awaiting latest PSA test result.

PIRADS 4; 37ml; PSAd 0.15 (should be 0.18 given 6.6 PSA); low diffuse T2 one side; no focal lesions; no other abnormalities / findings outside the prostate.

Biopsy results: Gleason 6 (3+3); T2 no MX (was told T2a but that's not stated in the report); 4 cores positive in left lobe accounting for 20% tissue examined; Perineural invasion present.

 

So, am (again) worried and that the PI part means there's a far higher chance of cancer spreading further. 

Has anyone else faced a similar situation and chosen to stay on AS or sort earlier treatment? The fact that its in the nerve raises questions too if nerve sparring is no longer a treatment option.

 

 

 

User
Posted 08 May 2025 at 09:27

Hello mate.

https://www.auajournals.org/doi/abs/10.1097/JU.0000000000002963#:~:text=Interestingly%2C%20after%20moving%20the%2050,should%20thus%20be%20further%20evaluated.&text=We%20acknowledge%20that%20our%20study,PNI%20and%20no%2DPNI%20cohorts.

 

If you look at research into PNI and active surveillance for low grade PCa, I think it's fair to say, that the the general consensus is that it does slightly increase the risk of AS failure but not by much.

 
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