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Perineural invasion with Gleason 6 - should I be concernerd?

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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 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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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.

User
Posted 09 May 2025 at 15:58

Thanks Adrian!

I see it concludes: "Perineural invasion should not preclude Grade Group 1 patients from active surveillance but they may warrant more stringent monitoring." 

My latest PSA has disappointingly gone up to 8.4 (from 6.6 three months ago at time of biopsy) - and that's with over 5 days off the gravel bike, albeit did 240 bumpy miles offroad the week before.

Really don't want to wait until it pokes itself out of the prostate with potential reduction in treatment options - I'm a rather nervous AS person, but at 59 equally don't want to launch into an operation etc. 

Cheers

Giles

ps - and thanks for all the info on your other posts - has saved me, and many others I'm sure, of google time and rabbit holes

 

 
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