Can Perineural Invasion in Prostate Cancer Be Treated?

Prostate cancer is the second most common cancer affecting men in the US.

Perineural invasion (PNI) refers to when cancer cells grow near or inside a nerve within the prostate gland. 

Read on to learn more about the meaning of PNI, its treatment, prevalence, outlook, and survival rate.  

Does perineural invasion mean prostate cancer has spread?

Perineural invasion doesn’t necessarily mean that the cancer has already spread to other parts of the body. However, it might indicate an increased chance of the cancer spreading beyond the prostate – to other parts of the body, such as your bones. 

In some cases, it can also mean your prostate cancer is more aggressive than prostate cancer without perineural invasion.

A 2015 study found a strong link between perineural invasion and metastasis (or spread) of prostate cancer to the bone. 

Over 600 men with prostate cancer participated in the study, and those who had perineural invasion had 11 times more risk of metastasis to the bones as compared to those without perineural invasion.

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Does perineural invasion in prostate cancer cause symptoms?

On its own, perineural invasion in prostate cancer doesn’t cause any symptoms. But if the cancer spreads to other organs, symptoms may develop (depending on which organs are affected).

There are usually no symptoms in the early stages of prostate cancer. When symptoms do eventually occur, they may include:

  • Blood in your urine
  • Frequent urination, which occurs especially at night
  • Pain when urinating
  • A weak urine stream

When prostate cancer spreads to the bones, it might present with fractures, fatigue, anemia, and bone pain. 

If it spreads to the brain, it might cause dizziness, headaches, and seizures. 

If the cancer spreads to the lymph nodes, it might cause them to feel hard and swollen.

Treatment for perineural invasion in prostate cancer

A doctor might recommend a more aggressive treatment plan for you if you have perineural invasion. This is because perineural invasion could indicate that your prostate cancer has a higher chance of becoming advanced and spreading to the rest of your body quickly.

Other factors that your doctor would have to consider when coming up with a treatment plan include your age, investigation results, and your overall health and well-being.

Prostate removal surgery

If you have perineural invasion, your doctor will likely recommend surgery to take out the prostate gland

It might also be recommended by your doctor to remove nerves located on both sides of the prostate. 

A downside to this approach is that your capacity to achieve or sustain an erection might be affected after the surgery.

You may also experience urinary incontinence after surgery

Chemo, radiation, or hormone therapy

Following the surgery, your doctor may also recommend chemotherapy, hormone therapy, or radiotherapy to ensure that the cancer cells that may have already metastasized outside the prostate gland are killed.

More research is still needed to help determine if different treatment approaches for perineural invasion can help stop future recurrence and improve outcomes. 

New treatment options may also be developed as scientists continue to gain a better understanding of perineural invasion in the prostate.

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How common is perineural invasion in prostate cancer?

A 2018 review of studies, which had a sample size of 13,412 men with prostate cancer, demonstrated perineural invasion to be present in about 31% of them (4,197 men).

74% of men who underwent surgery for prostate cancer were found to have perineural invasion in another study, and the sample size was 721 men.

What is the outlook and survival rate of perineural invasion in prostate cancer?

Within the scientific community, there’s still a bit of controversy as to the importance perineural invasion has in the diagnosis of prostate cancer. 

More recently, there’s been emerging evidence suggesting that perineural invasion may be useful in determining the outlook of prostate cancer.

An article published in 2019 showed an association between poor outcomes and perineural invasion. 

Perineural invasion is commonly seen in advanced tumors and is a sign of aggressive cancer. 

It has been shown to be associated with an overall five-year survival rate ranging from 50 to 64%.

A 2018 study found that perineural invasion is associated with a higher Gleason score. The Gleason score/scale is a system that is used by doctors to determine the severity of the cancer.  

The higher your Gleason score, the higher the chances of the cancer spreading fast.

Apart from PNI, some factors that may be used to assess your outlook include:

  • Tumor size
  • PSA level in blood
  • Involvement of lymph nodes
  • Imaging test results
  • How many lobes of the prostate the cancer affects


  • Perineural invasion occurs when cancer cells are found around or inside a nerve within your prostate gland. 
  • It generally means that there is a higher probability of the cancer spreading to other parts of your body. 
  • It is important to remember that perineural invasion is not the only determinant of prostate cancer prognosis. 
  • To determine your outlook and treatment plan, doctors use multiple approaches like the Gleason score, imaging test, and PSA levels. 
  • It is good to have a proper discussion with your doctor and ask questions whenever you are in doubt.
  • The information provided in this article is intended for general informational purposes only and should not be considered medical advice. 
  • It is not a substitute for professional medical consultation, diagnosis, or treatment. 
  • Always seek the advice of your physician or qualified healthcare provider with any questions you may have regarding a medical condition.

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  1. CDC. Prostate Cancer Statistics.
  2. Ciftci S, Yilmaz H, Ciftci E, Simsek E, Ustuner M, Yavuz U, Muezzinoglu B, Dillioglugil O. Perineural invasion in prostate biopsy specimens is associated with increased bone metastasis in prostate cancer. Prostate. 2015 Nov;75(15):1783-9. doi: 10.1002/pros.23067. Epub 2015 Aug 19. PMID: 26286637.
  3. Zhang LJ, Wu B, Zha ZL, Qu W, Zhao H, Yuan J, Feng YJ. Perineural invasion as an independent predictor of biochemical recurrence in prostate cancer following radical prostatectomy or radiotherapy: a systematic review and meta-analysis. BMC Urol. 2018 Feb 1;18(1):5. doi: 10.1186/s12894-018-0319-6. PMID: 29390991; PMCID: PMC5796578.
  4. Wu S, Xie L, Lin SX, Wirth GJ, Lu M, Zhang Y, Blute ML, Dahl DM, Wu CL. Quantification of perineural invasion focus after radical prostatectomy could improve predictive power of recurrence. Hum Pathol. 2020 Oct;104:96-104. doi: 10.1016/j.humpath.2020.07.005. Epub 2020 Jul 13. PMID: 32673683.
  5. Chen SH, Zhang BY, Zhou B, Zhu CZ, Sun LQ, Feng YJ. Perineural invasion of cancer: a complex crosstalk between cells and molecules in the perineural niche. Am J Cancer Res. 2019 Jan 1;9(1):1-21. PMID: 30755808; PMCID: PMC6356921.
  6. Warren TA, Nagle CM, Bowman J, Panizza BJ. The Natural History and Treatment Outcomes of Perineural Spread of Malignancy within the Head and Neck. J Neurol Surg B Skull Base. 2016 Apr;77(2):107-12. doi: 10.1055/s-0036-1579777. Epub 2016 Mar 10. PMID: 27123386; PMCID: PMC4846401.
  7. Kraus RD, Barsky A, Ji L, Garcia Santos PM, Cheng N, Groshen S, Vapiwala N, Ballas LK. The Perineural Invasion Paradox: Is Perineural Invasion an Independent Prognostic Indicator of Biochemical Recurrence Risk in Patients With pT2N0R0 Prostate Cancer? A Multi-Institutional Study. Adv Radiat Oncol. 2018 Sep 19;4(1):96-102. doi: 10.1016/j.adro.2018.09.006. PMID: 30706016; PMCID: PMC6349660.

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