Radiation follow-up after prostate removal
I had robotic radical prostatectomy in March of this year. During the pathology it showed perineural invasion and little bit in the margin (2 mm). My PSA result after the surgery was <0.13 down from 6.91. At my follow-up with my urologist, he suggested radiation because I had some at the margins. Given my PSA level is so low, would it be better to do active monitoring before I go right into radiation?
Hi
. Your questions about what a finding of perineural invasion (PNI) are certainly understandable. This is particularly true given that the science is unclear on what this finding means for biochemical recurrence (BCR). As this study on the topic found "PNI at RP is not an independent predictor of BCR:" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439219/. For your protection, we cannot give medical advice over the internet and the varied potential meanings of PNI make this all the more true. That said, your doctor should be able to further explain why he believes the immediate follow-up treatment is necessary in your case. I may simply be an assessment of better safe than sorry, but in the end the decision will belong to you. Wishing you the best and please feel free to keep us posted on how you are doing. Richard (ProstateCancer.net Team) I had a prostatectomy in February 2022. The pathology report show cancer at the margins. My urologist from Fox Chase Cancer Center, said the research shows no advantage to doing radiation at this time. He is checking my PSA every 3 months. You might want to get a second opinion. Thanks for the follow-up, I think my urologist threw that line in his write-up summary of my visit because he was pushing for active monitoring and my surgeon said had I not had the surgery when I did that it likely would have spread. They found .2 Millimeters incursions at the margin after my surgery in March. Similar to you, I am going back in August (3 month) checkup for another PSA test and discussion.
I have known men who almost immediately after surgery and with positive indicators outside the prostate were put on several treatment protocols - others were not. Personally I would keep on top of it. Would also be inclined to get a second opinion on possible next steps and would want to know the WHY's behind the recommendations .
Over all prostate cancer tends to be slow growing so you have some time to investigate and consider which path is best.
