Stage vs outcome

George59 · New User Joined: 27 May 2008 Posts: 8 Location: NY

Here is a simple question for the gurus out there. I have a palpable nodule (very slight) on the right lobe. The biopsy came back with Gleason 6, <5% volume on rt lobe; gleason 6, small focus <0.05cm left lobe. What stage is my cancer? T2a? T2c?

My surgeon said that due to the stage he could only promise a B+ result not an A+ with regards to nerve sparing. He is the type who underpromised and hopes to overdeliver. However, it does call to everyones attention when reviewing the literature that the stage of the disease at the beginning of surgery is very important in outcome expectations
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George

Replicant · Moderator Joined: 01 Nov 2006 Posts: 271

My understanding, based on websites like:
http://www.nccn.org/patients/patient_gls/_english/_prostate/3_stages.asp

and Walsh's book, is that your stage, as you describe it, would be T2c. It is palpable, and present in both lobes. The way I read the information on staging is that it doesn't have to be palpable on both sides to be T2c. It just has to be palpable somewhere, and present in both lobes.

As you probably know, staging is not exact at this point. A benefit of surgery is the examination of the entire removed tissue.

I highly recommend Patrick Walsh's 2007 book as a primer. There's a revamped website, Prostate Cancer InfoLink, at http://prostatecancerinfolink.net , that is full of authoritative help, as well. It has a medical advisory board headed by Dr. Judd Moul, head of urology at Duke University.

Best wishes.
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Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1, 11/08 <0.1
http://pcabefore50.blogspot.com

George59 · New User Joined: 27 May 2008 Posts: 8 Location: NY

This is what I thought but as I reread the guidelines and put a different sense to them I think they say:
T2a = DRI one lobe small
T2b = DRI one lobe >50%
T2c = DRI both lobes.
i.e., T1 is for non palpable and T2 is for varying degrees of palpability (is there such a word?). This seems to make some sort of logical sense.

It seems, logically, that the best outcomes advertised by the Docs are for patients who are diagnosed by chemistry alone. Those of us who were disgosed (sent for biopsy) because of DRI fall into a lower outcomes group.
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George

johnw100 · Posted: Thu Jul 03, 2008 5:31 pm Post subject: Re: Stage vs outcome

George,

There are a lot of gray areas with Prostate Cancer, including the subjective nature of biopsy readings and highly subjective findings of DRE examination, which is a difficult test to master, and where experts can disagree.

As your nodule is "very slight" another doctor might regard it as normal, or a less experienced doctor could fail to detect the slight abnormality.

The term "Palpable or visible tumor" is sometimes used: did what was seen by ultrasound during your biopsy confirm what DRE indicated ?

Things have changed a lot from the not too distant past when most PC was diagnosed at a later stage with nasty prostate lumps.

We can read various nomograms and the TNM Staging system, which is a guide, but not all lumps are created equal with the nature of the nodule being very relevant: someone with a slight nodule and technically Stage T2 could very well have a better prognosis than someone diagnosed as T1c.

As previously suggested the Surgical Pathology Report is more relevant to prognosis, and often indicates a different grade.

Best wishes.

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