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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2004Pre- vs. post-surgical staging?
My surgeon told me that my post-surgical pathology report was very good and assured me my prospects for a complete cure were high. I did know that the margins, seminal vesicles and lymph nodes were clar. At the time, I didn't press him for further details, and I've avoided the subject since then. I knew if I looked at the pathology report I might find something to worry about that probably didn't mean anything. I am now going on almost four years with undetectable PSAs, so my anxiety about the subject is somewhat reduced. I needed to send the pathology reports to a study of factors causing prostate cancer that I just enrolled in, so I snuck a look at the post-surgical report. It is pretty much as expected. But I did discover one thing that puzzled me. My presurgical staging was T1c, meaning that the doctor didn't feel anything on DRE. The post surgical staging was T2b. I presume this is based on an actual examination of the prostate from which a precise estimate of the size of the tumor(s) is possible. So if I understand correctly, all post-surgical staging is going to be T2 or higher, unless they find there was no cancer there at all. Of course, it would have been better if it were T2a, but it seems pretty clear the cancer was contained in the prostate capsule. On the other hand, a presurgical staging of T2b would have increased the likelihood of spread beyond the prostate (using the Partin tables), but since that apparently didn't happen, I presume the issue in now moot. Does anyone know anything more about this sort of thing? > My surgeon told me that my post-surgical pathology report was very good > and assured me my prospects for a complete cure were high. I did know [quoted text clipped - 22 lines] > > Does anyone know anything more about this sort of thing? Not me, but your posting is interesting. I dident want any of the details either so don't know what the final staging would have been. Maybe I'll ask if I think of it in June. What is the study you're enrolled in? Just curious. Dale J.  SignatureEmail: dalej2@mac..com >>My surgeon told me that my post-surgical pathology report was very good >>and assured me my prospects for a complete cure were high. I did know [quoted text clipped - 27 lines] > Maybe I'll ask if I think of it in June. What is the study you're > enrolled in? Just curious. I already posted an announcement about it. It is being conducted by someone named Burk, who is at the Albert Einstein School of Medicine. He is trying to study factors leading to prostate cancer among men of East European Jewish ancestry. I had to fill out a long form and collect samples from my mouth as well as send the pathology reports. Anyone interested in the study who missed my first posting should get in touch with me and I will send further details. > Dale J. I > It is pretty much as expected. But I did discover one thing that > puzzled me. My presurgical staging was T1c, meaning that the doctor [quoted text clipped - 10 lines] > > Does anyone know anything more about this sort of thing? Leonard, I think you are perhaps confusing "palpable" through the rectom with "palpable" given a lab environment. Your doc through some needles through your prostate and found cancer. He couldn't feel it on a DRE, so it was T1c. In the lab, after it was removed from your body, they could "feel" it and after disecting it, they found it consumed more than half of one of your lobes, but only one lobe; ergo T2b. If they had had to slice it and diced it to find it, it would still have been T1c. And yes, statistically, with a T2b, you would have had a great chance of recurrence. And yes, it is now moot. And yes, you probably did give yourself something more to worry about. But, as a seasoned citizen of 71 with a contained tumor and 4 years of undetectable results, you know as well as anyone that you worrying about it is an emotional manifestation not based on facts. > Does anyone know anything more about this sort of thing? Not me, but I think it'll be ok if you quit holding your breath now! Those stats sound terrific, and I can only dream of being there in four years. Congratulations. SignatureWake PSA 3.8, 11/2003 @58yrs Biopsy positive 5% in 1 of 10 cores T1c Gleason 3+3 RRP 1/12/04 Pathology agreed with biopsy + Negative margins Erection 1/30/04 Hi Leonard...Yes, what you say about pathologic staging is correct. The only rub is that when one is staged as pT2a or pT2b, one then also needs to know whether the pathologist was using the 1992 or 1997 TNM staging system, as these two stages mean different things in the 1992 and 1997 systems. This is explained better on p.151 of Walsh's book...Best wishes and good health, Ron ...snip... > It is pretty much as expected. But I did discover one thing that > puzzled me. My presurgical staging was T1c, meaning that the doctor [quoted text clipped - 10 lines] > > Does anyone know anything more about this sort of thing? hi leonard - in the for what it's worth dept. my pre-surgery stage was T1c. i just looked up my path report tonight and it stated that the prostate on the table was pT2c. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional > hi leonard - in the for what it's worth dept. > > my pre-surgery stage was T1c. i just looked up my path report tonight > and it stated that the prostate on the table was pT2c. See my other recent posting. I think this just means that they found cancer in both lobes, which is not at all unusual. The important part is the 2, which means it was contained in the prostate. Again, I think one would never have a post surgical stage 1 cancer reported. > ~ curtis > > knowledge is power - growing old is mandatory - growing wise is optional Hi Curtis...We were in the same boat, I was clinical T1c after biopsy and then pT2c (1992 staging standards) after pathology was done following the RRP. I remember being surprised and concerned that my stage had changed. I asked my doc how come I'm T2, was I mis-staged prior to surgery. He explained that the same TNM staging system is used for both clinical and pathological staging (a "p" in front of the stage identifies the staging as resulting from post- surgical pathology). During pre-treatment examination, if the tumor is found "incidentally", like from a biopsy or turp, then you are T1. If the tumor is "seen" or felt (e.g. non-incidental identification of the tumor), this can be by palpating it or by examining the entire prostate in the lab, you would be T2. So everyone who has a tumor will be at least pT2 following pathological examination of the removed prostate. You could be pT3 or pT4 if there is extension of the tumor beyond the capsule. On the other hand, it is difficult to assess spread beyond the capsule in the clinical environment unless some other surgical or imaging tests are run, so some men who are clinically staged as T2 may really be T3 or T4...Ron > hi leonard - in the for what it's worth dept. > [quoted text clipped - 4 lines] > > knowledge is power - growing old is mandatory - growing wise is optional |
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