A Grading Question

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Ron B - 04 May 2006 18:50 GMT

First, I want to thank you all for your help in bringing me from a
basket case upon diagnosis (10/04) to just a 'case' now. :-)

My RRP was done on March 21st 2005 by Dr. Catalona at Northwestern here
in Chicago.

The biopsy showed things as T1c and I know now that it's pretty good.
At 56, my first PSA was around 7..which led to the biopsy.

The surgery went wel and My PSA's have been undectable at 1 moth after
surgery, 6 month later, and just last week.

So things are going well.

Continence has improved (I went from Deends diapers, to guards, to pads,
to toilet paper, to nothing)...and I wear jockeys with no pads now
(since about 11 months after surgery)...so I'm very pleased.

My question...as I prepare to see Dr. Catalona for my yearly
appointment...I looked back at the good pathology report (neg margins
and nodes and SV) but saw that it was called PT2c Gleason 6...3+3

Now, I've read all the books and finally...and I thank you for your
patience...the question:

I know from the pathology that the tumor was in both lobes.

This accounts for the '2'... but since the DRE felt nothing...may I ask
what the T2c means?

The books are somewaht vague and say that the '2' means 2 lobes, but
since there was never any feeling of anything during the DREs...what
does it mean? It mentions a feeling of a tumor during the DRE, but I was
told that nothing could be felt.

Thanks so much.

My best to all,

Ron B.

Chicago

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Steve Jordan - 04 May 2006 19:50 GMT

On May 4, Ron B wrote, in pertinent part:

> I know from the pathology that the tumor was in both lobes.
>
> This accounts for the '2'... but since the DRE felt nothing...may I ask
> what the T2c means?
>

Sorry, the "2" has nothing to do with number of lobes involved. (Note
that staging includes T3 and T4 disease.) T2 means palpable tumors,
apparently not extending outside the gland.. The "c" means involvement
of both lobes.

Possibly the result of DRE was T1c, meaning nothing palpable in either
lobe. Obviously, this changed post-surgery.

> The books are somewaht vague and say that the '2' means 2 lobes, but
> since there was never any feeling of anything during the DREs...what
> does it mean? It mentions a feeling of a tumor during the DRE, but I was
> told that nothing could be felt.
>

There are two stagings, one is, for example, cT2c, which means clinical
findings (from DRE) of palpable tumors in both lobes. Or cT1c, clinical
finding of no palpable tumor in either lobe.

The other staging is pathological, resulting from examination of the
excised gland. An example would be pT2c.

For an exhaustive discussion, see this page of the Prostate Cancer
Research Institute's website:
http://prostate-cancer.org/education/staging/Pinchot_Clinical_Stage.html

Regards,

Steve J

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ron - 04 May 2006 21:18 GMT

Hi Ron...pT2c, the "p" indicates that this staging is based upon
examination of the pathology specimen, as opposed to the earlier
clinical stage (based upon DRE and biopsy or TURP). All tumors can be
seen and touched (or "felt") by the patholgist during examination of
the pathological specimen available after surgery. Therefor, pT2 is
the lowest stage possible for pathological grading, there is no pT1.
Clinical stagings such as T1c become, at least, pT2x upon pathogical
examination. The "c"indicates that tumor was found in both lobes...Ron

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Ron B - 04 May 2006 22:36 GMT

Thanks so much Steve and Ron.

Great answers as always.

What is very important, and what you have cleared up for me was the
difference between NOT feeling anything with the DRE prior to the
biopsy...and feeling something AFTER the prostate removal during the
pathology exam.

Indeed...there was a confined tumor in both lobes...and the path report
called it

PT2c Gleason 3+3=6

As always,

thanks so much.

Best of health to all,

Ron B.

Chicago

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Leonard Evens - 04 May 2006 22:33 GMT

> First, I want to thank you all for your help in bringing me from a
> basket case upon diagnosis (10/04) to just a 'case' now. :-)
[quoted text clipped - 25 lines]
> This accounts for the '2'... but since the DRE felt nothing...may I ask
> what the T2c means?

According to Walsh, there are two schemes, one from 1992 and one from
1997. Under the 1997 scheme 2b and 2c are subsumed under 2b. Walsh
prefers the earlier scheme, as, apparently, does your pathologist. 'T2'
means that cancer was found and 'c' means that cancer was found in both
lobes of the prostate. That is quite common.

You have to dsitnguish between the clinical staging, before surgery and
the pathological staging, after surgery, when the complete prostate can
be examined. Before surgery you were T1c because they couldn't feel
anything on DRE. The only way to be T1 after surgery is if no cancer is
found in the prostate. I'm sure that happens from time to time, but it
must be pretty rare, and I doubt if it happens with Dr. Catalona.

The important thing was that your cancer remained Gleason 6. Often, the
pthological grading goes up.

I don't remember seeing that interpretation of '2'. I'm pretty sure
that the distinction between T1 and T2 clinically is based on the DRE.
After surgery, with rare exceptions as noted above, everything is at
least T2. Often you will see this indicated with "p' in front, as in
'pT2c' where the 'p' indicates pathology after surgery.

> Thanks so much.
>
[quoted text clipped - 3 lines]
>
> Chicago

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RonL - 05 May 2006 04:49 GMT

> According to Walsh, there are two schemes, one from 1992 and one from
> 1997. Under the 1997 scheme 2b and 2c are subsumed under 2b.

Ah, thank you Leonard for this clarification. I guess it explains why own
my path report (MSK in NYC) reads "Staging (AJCC 1997): pT2b (confined to
the prostate & capsule, INVOLVING BOTH LOBES" [my emphasis]). Since
apparently under the old scheme the "b" meant "more than half of ONE lobe,"
I'm not sure whether that magnitude of relative volume is implied under the
new scheme.

Another point I'm not clear on is how they get the pG. Mine is given as
3+3. But ten or more sections of the gland were examined. I'm wondering if
that G6 really reflects analysis of *all* foci in all those sections.
...Another question for the surgeon, I suppose.

Good thread. -RonL

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Ron B - 05 May 2006 14:22 GMT

Thanks Len for the clarification.

Of COURSE the '2' doesn't...stand for 2 lobes.

I sense that I was getting rattled again just reading the report that
had been tucked away.

It is indeed the 'c' that refers to both lobes.

Thanks again.

Good health to everyone,

Ron B.

Chicago

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Steve Kramer - 05 May 2006 02:23 GMT

> The surgery went wel and My PSA's have been undectable at 1 moth after
> surgery, 6 month later, and just last week.

That's great news, Ron.

> This accounts for the '2'... but since the DRE felt nothing...may I ask
> what the T2c means?

Tumor palpable, but confined within the prostate involving both lobes.

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