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I am in need of your expertise!

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Old 01-15-2011, 02:24 PM   #1
Join Date: Sep 2010
Location: Stuart, FL, USA
Posts: 5
myfavfellow HB User
Question I am in need of your expertise!

I have been a frequent reader and rare poster to this board. My dad was Dx with PC in November 2009. He was 68 at the time with a Gleason of 6 (3+3) with 2 cores out of 12 positive. I believe one core was 10% and the other 40% positive. After much debate, research and prayer he decided to have a radical prostatectomy by Dr. Vipul Patel using the DaVinci Robot. We were told that the cancer was contained within the capsule of the prostate but I was able to look at his pathology report today....Here is the mini version:

Invasive Prostatic Adenocarcinoma
Pathologic Stage pT2a.
Gleason Grade 3+4 =7
Percentage of tumor involvement of the gland; 5%
Surgical Resection Margins: Tumor Free
Lymph Nodes: None Submitted

Tumor Summary:
(Some repeat of the above which I will spare you then>>>
Tumor location: Right side of the prostate
Tumor size 0.6 cm
Extraprostatic extension: Absent
Resection margins: Tumor Free
Seminal Vesicle Invasion: Absent
Perineural Invasion: Present
Angiolymphatic invasion: Absent
Other findings: Extensive areas of prostatic atrophy (may be from his TUNA procedure?)
And again....Pathologic stage pT2a ; N not known; M not known

So you see where my concern lies...the word "invasion"
I tried to research it on my own and most of the articles said that Perineural Invasion is a most important diagnosing factor with needle biopsy but NOT after prostatectomy. I am soooo confused.
My dad sees the office personnel again on Monday (doubtful he will see Dr. Patel) and I will get him to ask at that time what it means. But even then....I trust you more. Can you please help? That word made my heart grip.
Thank you so much for your time

Last edited by myfavfellow; 01-15-2011 at 02:25 PM.

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Old 01-15-2011, 09:24 PM   #2
Tall Allen
Join Date: Aug 2010
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Re: I am in need of your expertise!

Congratulations -- those are good findings.
There are many studies of whether perineural invasion is an independent risk factor in the absense of positive margins or extracapsular extension. They almost all conclude it is not. Here's an a recent example:

"PNIp was not an independent prognostic factor of biochemical serum recurrence or cancer-specific survival."

If it were found on an earlier biopsy, it might have predicted extracapsular extension, which in your father's case, was thankfully absent. Extracapsular extension IS an independent risk factor, as are positive margins -- neither of which were found on your father.

The surgeon probably cut out those nerves on that side that they found the perineural invasion.

- Allen

Old 01-16-2011, 07:00 AM   #3
Join Date: Sep 2010
Location: Stuart, FL, USA
Posts: 5
myfavfellow HB User
Re: I am in need of your expertise!

Thank you so much Allen! I just did not like that word "invasion" at all. As I understand it both nerve bundles were saved. I went up with my parents for the surgery but was unfortunately unable to go when they met with Dr. Patel post op. We live 2 hours away and I was working that day. So I did not hear the report first hand. I was perusing through the internet articles and it was difficult to figure out if it mattered much or not.
I appreciate your response and I will breath a little easier. What a journey this is and I am thankful for this board with all of its information and support.

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