Does the presence of perineural invasion on a prostate biopsy change your management decision?  

I would consider perineural invasion as one of the "soft" criteria that may help impact treatment decisions. Previously this would have also included such things as Gleason 3+4 vs. 4+3, Gleason 8 vs. 9-10, or the percentage of positive cores. However, as these factors have now been included in the ...

In the world before mpMRI, PNI was associated with ECE on pathologic specimens. If I see PNI, especially in lateral cores, I always order a mpMRI to r/o ECE.