That old Chesnut Perineural Invasion & Feelin Depressed over ED

Its been some time since I last wrote anything on the blog so I thought I would give you all an update. Back in work with a very active job and lots of travel, long hours and pressure - loving it. Though I am getting really tired. Its a different type of tiredness than I used to get before the PCa. Aches and pains have started to creep in and I keep thinking of that Pathology report that said Perineural Invasion(PNI).

Sitting in hotels at night on your own gives you time to think and to read. I must have read so many papers on the topic of PNI. What has now fascinated me is the nerve structures around the prostate and their relationship to the Erectile Dysfunction that's getting me down, and also how they relate to PNI and the spread of cancer cells outside of the Prostate.

I had wondered why with only a Gleeson 6, why there was this immediate need for me to have treatment other than active surveillance. I had pondered over all the risk factors, genetics, family history. But now, having read so many papers on PNI I can see that if PNI was found on biopsy ( and it was found in my pathology ), its an indication of a more aggressive cancer and a prognostic ( if that's the word ), for more urgent treatment. So I can see why they recommended and why I have surgery.

Thing now, is that I thought why the NHS consultant said if the cancer was on the right, he would not save the 'right' hand side nerves. I never asked him why? Was it related to PNI. All the articles that I have read recommend with PNI that they remove those nerves where there is potential for PNI spread.  Now I had bilateral nerve sparing. If Mr D wasn't aware from Shrewsbury about the PNI, he wouldn't have been appraised of this risk factor.

So I have had nerve sparing, but this now gives me that worry about biochemical recurrence. Cancer was found surrounding nerves in the prostate and these nerves do pass through , outside the prostate, some to the sex nerves and elsewhere. Apparently, the cancer cells can use the nerves as a highway to escape. It might only be one or a couple. They can remain undetected for a number of years elsewhere in the body, it depends I suppose how many of the blighters may have escaped. Hopefully none. But if any have , I will always have that nagging doubt that the cancer will return one day. There is a short article here :  http://www.ncbi.nlm.nih.gov/pubmed/10759668

The ED front does get me down. Its hard not to think about it each day. But the daily drugs, the pump exercise. Oh, to be awoken at night by some stirring , or that morning surprise men have. Well not yet, and nothing of notability that could reasonably engage in a penetrative adventure. We wait and see and must keep cheery. Two counseling sessions a month are helping and recently I attended the Prostate Cancer Survivorship Conference in Birmingham where this was discussed, as were Holistic Therapys that help sort the mental and emotional aspects out. ( Its not manly to admit, but I did break down in the car the other day when listening to a tune on youtube - the emotions drained out of me - had a facecloth available to erase traces of moisture before anyone could see ).

Bit of good news, GP is giving more Viagra and more Cialis - just a shame they cant be used more purposefully.

Enough for now.

 

I borrowed the above picture - cant remember the source, but when I do I will acknowledge the author and any copyright. It does help explain things and why you can have leakage without having positive margins.