On September 28, RML wrote, in pertinent part:

There should have been a letter, a b or c, following the number. Someone
made a mistake.

The clinical stage, properly called the TNM staging, should be
expressed, for example, in this manner: T2aNXMX.

TNM means Tumor (lymph)Nodes Metastases.

T2aNXMX means Tumor, palpable, involving 50% or less of one lobe, status
of nodes unknown, status of metastases unknown.

I see that this was a *surgical* path report, not based upon clinical
(pre-surgery) findings, though, so the a b c might not be applicable.
Recommendation: ask the uro.

It's interesting to note that the uro admits that he does not know
whether the lymph nodes are involved. If they were NOT involved, the
report should have read "N0" meaning nodes zero.

A full explanation is found here:
http://www.prostate-cancer.org/education/staging/Pinchot_Clinical_Stage.html

Regards,

Steve J

"The thing is to expect nothing in particular, but (to) be aware of the lack
of enforceable guarantees or enforceable contracts with
nature/god/entropy as to the condition or durability of our bodies."
-- Brian Brunner, PCa survivor, December 12, 2005 on The Prostate
Problems Mailing List
Thank you, Brian.

They certainly are not consistent, a fact I've noted a couple of times
before in this newsgroup.  They are not even within each others error
bars, if I remember correctly.  I think that there is no chance their
predictions are both right after suitable interpretation.   Before
expressing my opinion about which you should believe, let me explain
briefly how they appear to differ in methodology, and how that might
explain the differences.

Both methods use large databases of results of treatment, but at
different medical centers.  The both claim to be able to predict
recurrence within 7 years.  The Sloan-Kettering studies used
conventional statistical techniques to analyze the data.  Also, their
projections take into account improvements in results over time, which
are apparent in the data, in making predictions for the future.  So the
predictions are not just a simple reflection of what the data show.
The prostatecalculator.org uses methods based on neural nets.  This is
supposed to detect patterns by 'learning' from the data.  I don't know
if they included any correction because of improvement in results over
time.   The prostatecalculator method doesn't allow as many gradations
of input data as the Sloan-Kettering calculator.   For example, it
groups all pre-treatment PSA over 4 in one group, whereas the
Sloan-Kettering calculator allows you to break it down into smaller jumps.

I think the Sloan-Kettering results are more reliable.   First, the
statistical techniques they use are well established.   Second, they
have been well confirmed by testing at other institutions.  Third,
Scardino and colleagues have done a followup study taking the
predictions to 10 years, and the results are consistent with the
previous results.  Finally, the Sloan-Kettering results are similar to
what Walsh, et. al. report from studies done at Hopkins using
statistical tehcniques similar to those used by Scardino and colleagues.

So what might explain the differences?   The first possibility is that
the study populations are very different.  The patients at the Ford
Cancer center may have had their cancers detected significantly later,
the surgeons there may not be very good at removing cancers, or there
might be some other difference.  I already mentioned the issue of
whether or not they included a correction to account for improved
results over time.  But it seems implausible to me that these factors
could explain the great difference in results.  I think the explanation
is in the methodology used to analyze the data.  Neural net methods have
been used successfully in a variety of circumstances, but it also seems
plausible to me that they could have messed up in how they designed
their algorithms.

Of course, it may be that neither calculator is a reliable guide, but I
would go with Sloan Kettering.  Its calculator is based on research
which has appeared in peer reviewed journals and which was done by
researchers who are highly regarded in the field.  It has been verified
at other major medical centers throughout the world, and is consistent
with what Walsh reports.  Tewari, the lead author of the
prostatecalculaor study, also appears to be a respectable researcher,
but it seems to me his results are the odd man out.

Since it was on both sides, it would be classified as T2b.   It is very
common after surgery to find cancer at a variety of sites in the
prostate and in both lobes.

Path is good. This is final path staging, not clinical stage.
www.prostatecalculator.org is primarily based on partin nomograms
looking at clinical (pre-surgery or pre-rt) parameters like PSA and
biopsy grade.

It's bilateral, so it is:   pT2b

Before surgery, if you had right and left biopsies with cancer, you
already know it's bilateral, so logically, you would think T2b, right?
No.. since it was detected by PSA, with normal DRE, regardless
of the biopsy results, it is:  cT1c  ("clinical" T1c, aka, normal DRE)

Nodes.. if the nodes were removed and clean, then you would be:
N0 (N-"zero"). If nodes were not removed, then there is no way to
know, for sure, hence:  NX.
Nodes were likely left alone, because your pre-op PSA and biopsy
were all low-risk. Take your preop PSA and biopsy, and plug into
prostatecalculator.org, and you probably have <1% chance of having
disease in lymph nodes. Risk of major complication from lymph
node removal is probably as high as 3-5%. So, for such low-risk
cancer, many surgeons do not do lymph node dissection. But,
your surgeon should have inspected the nodes to see if they looked
grossly abnormal or suspicious. I always do. Also, let's say you are
extremely unlucky and are in the <1% with lymph node involvement
and the nodes were removed or not removed, either way, you are
probably going to get adjuvant hormones. If nodes removed and
found to have CA --> hormones.  If nodes not removed and have
cancer in them, then your
PSA will probably not go to <0.1  --> hormones.

Summary, you have low-volume, low-grade, negative margins.
Your PSA will almost for sure be <0.1 at 1 month and hopefully..
forever.  Congrats.