PNI in biopsy

User

Posted 03 Oct 2025 at 09:46

I have been on AS for 10yrs with an initial finding of G6 and PSA under 2 from 5% in one of 12 cores with an identified lesion on the right of around 0.5cc, but the positive core from the left?

Over the preceding years I have had 6 monthly PSA and MRI scans every 1 to 2 yrs. Brother was diagnosed in 2017 and underwent RP in 2017.

In 2022 there was a slight increase in the right side lesion, PSA under 3, so repeat bi-ops were done on the lesion, 2 out of the 5 cores positive for G6, PIN and PNI not present. so carried on with AS.

However, it was noted there there was a lesion on the left side that was becoming more prominent.

in April 24 PSA was 3.13 and a MRI was now able to give volume dimensions of the left lesion of around 0.5cc.

However, in Oct 24 PSA had risen to 4.34 and 4.84 in Apr 25 to 5.65 in July 25.

MRI in July gave fairly stable conditions but note slight increases in the volume of both lesions.

NO, MO, EPE-NO and Seminal vesicies-normal and T2 staging.

With the repeated rises in the PSA's I could not stay on AS without repeat bi-ops.

These were limited and targeted only to the left and right lesions.

A total of 5 cores were done, 3 from left and 2 from right all have come back positive with an overall Gleeson score of 3 + 4, which is disappointing, but clearly much better than a 4 + 3.

As a result following their MDT meeting I have been advised that I now need to seek active RP or RT.

However, the deep concern for me is that the bi-op results has come back with PNI being present, but EPE and vascular invasion being absent.

For he first time in the last 10yrs I am now very concerned and yes frightened as PNI would appear to be a clear route for the cancer to migrate through the rest of the body with a poor prognosis, if it has not already done so, not a position I would have expected to be in while being on AS.

Is my concern and fear realistic?

It is most likely that I will undertake SABR as it has become available locally, is that likely to be curative?

Edited by member 03 Oct 2025 at 11:46 | Reason: text change

User

Posted 03 Oct 2025 at 14:30

Rudge, I would look at it as your AS has served you well.You have hopefully had ten years with out too many side effects and now is the the time to bite the bullet and hope the side effects are minimal.

I had surgery on the basis that the cancer was contained, histology showed it wasn't but I think scans etc are better than 12 years ago.

Perhaps call the nurses on this site for an informed opinion of your options.

Thanks Chris

User

Posted 03 Oct 2025 at 14:37

7 years ago my diagnosis was much worse than yours, and it did include PNI. After RT my PSA is 0.1 . OK we don't know what the future holds and we are all different, but PNI is unlikely to cause you any problems. As Colwickchris says, you have had 10 years with no side effects, that is a good result. Also now you do need treatment SABR is available which is an improvement on the treatments available 10 years ago.

Dave

User

Posted 04 Oct 2025 at 17:23

Thanks for the replies.

Yes I have been 'lucky' to have had 10yrs with only the fairly minor inconvience of PSA's, MRI scans and bi-ops, but now I recognise it is time to have treatment.

As expressed, my concern now is that PNI has been reported on the last bi-ops, the extent or grade associated is not know other than it is present nor what the the implications may be for the future as a result of it?

Unfortunately, none of the information that is avaialable is very favorable, which is a bit of a blow.

Edited by member 04 Oct 2025 at 17:25 | Reason: Not specified

User

Posted 04 Oct 2025 at 21:58

Hi, I'm new to the forum but I have read the posts which give lots of good information. It does show that everyone is different. My personal background that I had regular tests over the years due to my father having PC which spread and ultimately caused his passing.

In 2023 my PSA test showed 4.4 and my GP practice referred me to a NHS Diagnostic Centre. A bioposy following a MRI scan show a Gleason 3.3 and suggested Active Survillance. Over the past 2 years I have had 3 monthly PSA checks with the last being done showing PSA of 6.4. I also had another MRI last December which showed no real change form 18 months earlier. However, it is now almost 6 months since my last PSA check (April 2025) and, on contacting the NHS Trust, I was informed that I'm on the waiting list for a consultation. I'm concerned about the delay and will likely get my local GP practice to do a PSA test in lieu of a consultation with the Diagnostic Centre.

My current thinking is that I should have a radical prostectomy to remove any cancer before it has the opportunity to spread, although I do accept the issues in having the removal.

I'd like any views on my options to consider based on your experiences. I'm 69, fairly fit, golfing 2 days a week and walking a couple of miles on the other days, with a weight of around 75KGs (11.5 stone).

Like many, it's always a bit of a worry prior to having a PSA test in event of an big increase.

Many thanks

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