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Pni significance

User
Posted 09 Oct 2025 at 14:19

Hi all.  I had a RALP about 7 weeks ago and got my post op appointment oct30.   My stats were glesson3+4   Pattern4 less 10%.  T2n0M0   Left side tz zone tumor   Pni present. The thing that bothers me going forward is the Pni present finding    I have read lots about it and there seems to be conflicting reports of the significance of Pni.    Has any one got any insights.   Cheers everyone.   Simon 

User
Posted 09 Oct 2025 at 18:21
Hi Simon

I hope the recovery is going well!

As you say, lots of conflicting info on the relevance of PNI from 'don't worry about it' to not suitable for AS or potential for PCa recurrence . There are some other threads on PNI here if you do a search. What was your PSA and PSAd before / at a couple of months ago? Has your Gleason score stayed as pre RALP estimates?

I have a similar diagonsis but pre treatment at 3+3 plus a relatively high PSAd (ratio of PSA to prostate density) of over 0.2 - with that & PNI together my Urologist is suggesting a move away from AS and towards treatment. The inference is from the higher PSAd that the Gleason score may be under estimated, and then PNI becomes more of a potential issue if left untreated. I may well have a follow up MRI & biopsy to be sure on any decision.

Overall I glean that PNI often indicates to clinicians to move more quickly towards treatment and this you have already done (albeit maybe without knowing about the PNI beforehand). Your post op meeting should be able to give you comfort and you may want to ask the prevelance / % of PNI in the pathology report. Given that it was T2, and presumably no PCa at the margins or prostate bed, there is hopefully little to worry about.

I can imagine you'll be well armed with questions for the next meeting - and good luck!

Cheers

Gi

User
Posted 09 Oct 2025 at 18:56

I had PNI and wasted far too much time researching it. It can be detected in over half of biopsies, some research place it as high as 84%. In the grand scheme of things it is much less important than PSA levels Gleason score, staging etc.

To put my mind at rest, I turned PNI into Prognositically Nearly  Insignificant. 🙂

Edited by member 09 Oct 2025 at 19:13  | Reason: Additional text

User
Posted 09 Oct 2025 at 19:16

My psa at diagnosis was 21.  Ive had had a psa since inital diagnosi but i was advised by oncologist that treatment was needed but throughout all my appointments pni was never brought up and i only noticed it as it was at the bottom of my letter i received after the biospy.     I think i will put it to the back of my mind as most studies ive read say it irrelevent and the glesson and psa are the over riding factors.    Cheers.  Simon.    Ps.  Recovery is going well 

 
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