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Help - Frustrated Not knowing Stage

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Prostate Cancer
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Posted 3/12/2008 8:59 AM (GMT -8)
Hi -

There are so many "calculators" - the one mentioned here today, the Partin and Han Tables, and others we have found. Their predictions of future PSA involvement, likelihood of extra capsular penetration, 5 year & 10 year survival, etc are all very dependent on an accurate Stage - even prior to surgery or treatment. We have never had a "Stage" noted by doctors, or biopsy reports. We even had 2nd opinion on biopsy to confirm. We are unsure if it should be a T1C or T2C and the percentages are vastly different depending on this.

The original Urologist who performed biopsy said "unremarkable" on the DRE, but also noted Left side very slightly enlarged. The Volume of the prostate was 32 cc at the biopsy (via ultrasound). There were 10 cores taken and 4 were positive for cancer, ranging from 5-20%. Three were Gleason 6 and 1 core a Gleason 7. We recall the Urologist saying it was in 'both lobes', but not sure where he got that.

Resident we talked to before surgery (WHICH IS IN 5 DAYS - eek!) said "No matter, it will be properly staged after surgery." Any ideas, from all you experienced ones, on what we should interpret about the "stage" at this point?

Thank you,

FairRider
Posted 3/12/2008 9:10 AM (GMT -8)
This link has a nice break down:

http://www.phoenix5.org/staging.html

Examples:
T1c  Tumor identified by needle biopsy due to elevated PSA 
T2c  Tumor involves both lobes 

Posted 3/12/2008 9:20 AM (GMT -8)
Thank you so much for that link - it IS a good visual of Staging. The problem is, I get all that, and just am not sure where we fall - t1c,t2c?

I guess all we do is have surgery so we can have an accurate staging.....hmmm...perhaps I will call the Lab and ask how to interpret, based on where cores where taken etc.

FairRider
Posted 3/12/2008 11:29 AM (GMT -8)
You have similar questions that I had about these tables. I studied (obsessed?) over them a great deal. A risk that we all share is that the clinical interpretation of the stage can "under-stage" the true extent of the cancer, and this can only be known on the post-surgery pathology. However, I interpreted the Partin Tables as probabilities based on the CLINICAL stage. In other words, the risk of under-staging at the clinical level is already "baked into" the probabilities for the Partin Tables. I welcome correction if someone disagrees. Your doctor should be able to tell you the clinical stage and give you reasons for the staging.
Posted 3/12/2008 1:24 PM (GMT -8)
Thank you again for a great reply. Only problem, we get no Stage from our original Urologist, who will not talk to us until 3 months post surgery because we are going to a different surgeon.

Maybe predictions and probabilities don't really matter in the end, but all these 'calculators' are begging for use to help decide treatment, etc. It seems like another paradox. The 'scientists' are trying to offer "scientific data' and scientific method, but that doesn't seem that useful if the DRE implicates 'stage', but it is a matter on one person's finger feel of a gland - rather subjective. Sometimes 'science' isn't always as exact, or precise, as we give it credit for, particularly in medicine.

I still guess we go for the 'cut', in part, to acquire an accurate staging of the cancer. It seems science might be able to provide a more precise & less invasive way to 'stage' this disease. (I must be in the 'anger' stage...)

FairRider's Spouse
Posted 3/12/2008 4:39 PM (GMT -8)
FairRider,

T1 means they detcted cancer on either the left side or right side of the prostate.  T2 means they detected cancer on both sides.  Either way, your headed to the same conclusion.  Your Gleason scores tell you that you definitely have cancer and that at your relatively young age they will recommend removing the prostate and probably the lymph nodes in the area.  If you don't have a copy of your pathology report, ask for it and they will send it to you.  Mine came with a good explanation of the results. 

I've been in science and engineering my whole career and I also had the natural reaction of needing data and looking up things like survival statistics.  All of the papers I've read the average age of the populations in the study were 68 to 75 years old.  At that age a lot of the people may be surgical risks or not have long enough life expectancies where they will undergo the surgery.  The statistics can be misleading because there isn't enough data on people your age because anyone with the cancer at your age gets the prostate removed. There aren't too many people willing to let it go and see what happens for the sake of science.  I have have a PSA of 0.75, Gleason of 3+3 and T1C.  All of mine is on the left side and one region had 50% cancer.  I have decided to have the surgery to knock it out so I can get on with my active life.

Good luck and remember that the doctors work for you.  You should ask as many questions as you want and call their office if you want to ask any follow-up questions.  Definitely get a second opion.   Your doctor probably expects that.

Posted 3/12/2008 4:44 PM (GMT -8)

I think that the color doppler is maybe the best procedure that will show the existence and extent of any Pca.  Don't think it is widely known about or used.

Dutch

Posted 3/12/2008 6:15 PM (GMT -8)
Hi FairRider,
You are T1C unless you had a positive (palpable) DRE. I too made the same mistake of seeing both lobes having a positive core sample but that is not clinically stage 2 disease. If your DRE was negative then you are not a T2 patient.

Note the Phoenix5 link in Steve's post has been changed. (My Seminals were involved and I am classified now as T3b, not T3c like the chart suggests. This change was in 2005. This was the only change to that chart)

Tony
Posted 3/13/2008 8:05 PM (GMT -8)
Hi FairRider

You should NOT have to wait 3 months for your post op pathology report. When Rick had the cath removed 5 days after surgery the pathology report was ready. We went over it with the Dr. & I brought home a copy of it so I could post it on this web site and get help to better understand it. Please remember You are hiring these Doctors to work with you on this case & you need to feel like you can call the Doctor & expect an answer in a reasonable amount of time. 3 months in way too much time to wait for a pathology report. I wish you the best of luck during your surgery & recovery.

Warm Wishes

Diana 

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