Pathology Staging Terms

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Arnie
Regular Member


Date Joined Aug 2009
Total Posts : 374
   Posted 12/8/2009 7:54 PM (GMT -6)   
I should  know this by now, but what does the NO MX stand for/represent in the post surgical report? I've seen different variations such as Nx MX (I think), but for the life of me, I can't remember to ask my urologist on any of the occasions following surgery! Perhaps it was explained to me immediately after the report came out, and it didn't register.
 
Much obliged,
Arnie in DE
Age 56 (biopsy & surgery)
PSA at Diagnosis-3.9
Biposy 8/19/08--4 of 12 cores positive; 5% involvement, Gleason 6 (3+3)
 
Surgery 1/26/09-DaVinci Robotic Prostatectomy at Presbyterian Medical Center/HUP-Phila, PA
Dr. David Lee
 
Pathology Report- Adenocarcinoma, no capsular involvement, seminal vesicles clear, lymph nodes clear, negative margins, Gleason 7 (3+4), Stage T2C, Prostate 61.8 grams, gland involvement 2-10%
 
Catheter removed after 8 days, totally dry at 3 months. ED issues continue, Viagra (via ADC) nightly (100mgs), VED use in earnest at 6 months. "Ball Park Frank" plumping at this point......ED at 10 months continues to improve, albeit slowly. Continued daily use of 100mg Viagra (ADC). Discontinued pump use; manual stimulation to varying states of erections; achieved penetratable erection on a couple of occasions
3 month PSA--<0.1
6 month PSA--<0.1
10 month PSA--<0.1


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 12/9/2009 7:27 AM (GMT -6)   
Sure here is a good answer Dr. Strums book near back of the book with photo-pictures in the 2nd Edition of A Primer on Prostate Cancer Page G5 area.

Regional Lymphnodes (N): (some paraphrased)
Nx: regional lymphnodes cannot be assessed.
N0: no regional lymph node metastasis
N1: mets in single lymphnode, 2 cm or less in greatest dimension
N2: mets in single lymph node, more than 2 cm but not more than 5 cm in greatest dinension; or mulitple lymph node mets, none more than 5 cm in dimension
N3: mets in lymph node more than 5 cm in greatest dimension

Distant mets (M):
MX: presence of distant mets cannot be assessed (at the time)
MO: no distant mets (known)
M1: distant mets (known)
M1a: nonregional lymph node(s)
M1b: bone(s)
M1c: other site(s)

This helped me remember this stuff, I have not looked closely at this for years now. As patients you want to see the No & Mo findings vs. the other things, even with bad stats alot of times patients are not staged in these parameters...cause may still be unknown. and thus given an Nx & Mx (like in my case...even with clear scans...not definitive enough).

Post Edited (zufus) : 12/9/2009 5:31:18 AM (GMT-7)


Arnie
Regular Member


Date Joined Aug 2009
Total Posts : 374
   Posted 12/9/2009 11:08 AM (GMT -6)   
Beautiful....thanks, Zufus. You can see by my signature where I am, but this also helps me understand where others are as they post their respective stagings
Greatly appreciated.
 
Arnie in DE
Age 56 (biopsy & surgery)
PSA at Diagnosis-3.9
Biposy 8/19/08--4 of 12 cores positive; 5% involvement, Gleason 6 (3+3)
 
Surgery 1/26/09-DaVinci Robotic Prostatectomy at Presbyterian Medical Center/HUP-Phila, PA
Dr. David Lee
 
Pathology Report- Adenocarcinoma, no capsular involvement, seminal vesicles clear, lymph nodes clear, negative margins, Gleason 7 (3+4), Stage T2C, Prostate 61.8 grams, gland involvement 2-10%
 
Catheter removed after 8 days, totally dry at 3 months. ED issues continue, Viagra (via ADC) nightly (100mgs), VED use in earnest at 6 months. "Ball Park Frank" plumping at this point......ED at 10 months continues to improve, albeit slowly. Continued daily use of 100mg Viagra (ADC). Discontinued pump use; manual stimulation to varying states of erections; achieved penetratable erection on a couple of occasions
3 month PSA--<0.1
6 month PSA--<0.1
10 month PSA--<0.1


Arnie
Regular Member


Date Joined Aug 2009
Total Posts : 374
   Posted 12/9/2009 11:12 AM (GMT -6)   

P.S.---------realized I hadn't completely updated my staging after asking for this info-----

Arnie in DE

 

 


Age 56 (biopsy & surgery)
PSA at Diagnosis-3.9
Biposy 8/19/08--4 of 12 cores positive; 5% involvement, Gleason 6 (3+3)
 
Surgery 1/26/09-DaVinci Robotic Prostatectomy at Presbyterian Medical Center/HUP-Phila, PA
Dr. David Lee
 
Pathology Report- Adenocarcinoma, no capsular involvement, seminal vesicles clear, lymph nodes clear, negative margins, Gleason 7 (3+4), Stage T2C, NO MX, Prostate 61.8 grams, gland involvement 2-10%
 
Catheter removed after 8 days, totally dry at 3 months. ED issues continue, Viagra (via ADC) nightly (100mgs), VED use in earnest at 6 months. "Ball Park Frank" plumping at this point......ED at 10 months continues to improve, albeit slowly. Continued daily use of 100mg Viagra (ADC). Discontinued pump use; manual stimulation to varying states of erections; achieved penetratable erection on a couple of occasions
3 month PSA--<0.1
6 month PSA--<0.1
10 month PSA--<0.1


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 12/9/2009 3:29 PM (GMT -6)   
You are welcome Bro, and continued success in your journey. You probably can be helpful to someone else, even local guys whom are just looking at this dragon need to talk to travelers whom been there and done such.

Strum says that almost 50% of men at age 50 have PCa, alot of them don't know it (yet), alot of them have or get found with indolent forms or low stats is what is commonly found on the majority of patients....that was the good news part of it, although that still isn't good news.

So for it being rare and such, at age 80 supposedly 80% of men have PCa, most still don't die from it. So this thing is more common that most people even realize.

Arnie
Regular Member


Date Joined Aug 2009
Total Posts : 374
   Posted 12/9/2009 4:01 PM (GMT -6)   
Zufus, you are so right............I have a friend, my age, who has been looking at his PSA rise over the last 1 1/2 years. His GP is monitoring, but he went from 2.4 to 3.3 in 6 months, and still wasn't advised to get a biopsy or referral to a specialist, even knowing that his Dad died as a result of advanced prostate cancer. Although I'm hoping against hope, if I was a betting man-------well you get the picture. He's due for another PSA right now, and even if it rises significantly, I'm anticipating resistance to a biopsy even if it's advised by his MD. Hopefully the GP will make a referral to a urologist, and that will be enough of a hammer. But this is so prevalent, that I know I'll be advising more than just him along the way. And the more I know, the more I find I don't know. I, like the rest of us, keep trying to acquire as much info as possible so we can be agelp to those of us yet to come this way.
Thanks again for the info,

Arnie in DE
Age 56 (biopsy & surgery)
PSA at Diagnosis-3.9
Biposy 8/19/08--4 of 12 cores positive; 5% involvement, Gleason 6 (3+3)
 
Surgery 1/26/09-DaVinci Robotic Prostatectomy at Presbyterian Medical Center/HUP-Phila, PA
Dr. David Lee
 
Pathology Report- Adenocarcinoma, no capsular involvement, seminal vesicles clear, lymph nodes clear, negative margins, Gleason 7 (3+4), Stage T2C, NO MX, Prostate 61.8 grams, gland involvement 2-10%
 
Catheter removed after 8 days, totally dry at 3 months. ED issues continue, Viagra (via ADC) nightly (100mgs), VED use in earnest at 6 months. "Ball Park Frank" plumping at this point......ED at 10 months continues to improve, albeit slowly. Continued daily use of 100mg Viagra (ADC). Discontinued pump use; manual stimulation to varying states of erections; achieved penetratable erection on a couple of occasions
3 month PSA--<0.1
6 month PSA--<0.1
10 month PSA--<0.1


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25394
   Posted 12/9/2009 4:04 PM (GMT -6)   
Zufas, another staging question for you.

My final pathology is T2C. I can't remember, perhaps it was Tony that mention in passing that they were changing some of the staging system. I think all Stage 4 is jsut Stage 4, and I could be wrong, thought it was said that T2C were going to be changed to a Stage 3 rating.

I have often wondered in my own case, was told it was contained, then told there was one positive margin. Do you think they keep it stage 2 until they see proof that some PC actually went over the edge, i.e. reoccurance? But then we have stage 3 guys that years later show no evidence of reoccurance. You can see where that is confusing?

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys ,cath #8 33 days, Cath #9 in 35 days, 12/7/9 - Cath #10 in place


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 12/9/2009 4:39 PM (GMT -6)   
David I think I remember somewhere too that the T2c was going to be dropped and listed as T3, but it was only a proposed idea and not generally accepted mainstream....(still looking for the article). The addition of a positive margin was also listed as a suffix of R1 (pT2c N0MX R1) and if for some reason the cancer is restaged it is prefixed with a small r to replace the small p (rT3 N0MX)

Recurrence alone normally won't restage the cancer unless mets are confirmed in the bone or lymph nodes later on.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08
                 12 month Oct 2009 .09 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/9/2009 4:49 PM (GMT -6)   
I think the above numbers are from the AJCC 1992 cancer staging manual. The current manual is AJCC2007 and I don't have that one. I do have the AJCC2002 manual in front of me and here is the TNM system in the manual:

T1a positive tissue is less than 5% of the tested tissue
T1b positive tissue is more than 5% of the tested tissue
T1c Tumor is identified by needle biopsy after an elevated PSA test (Most of us here)
T2a Involves 1/2 of one lobe
T2b Involves more than 1/2 on one lobe and the other lobe is negative
T2c Involves both lobes
T3 Extension to periprostatic tissue
T3a Unilateral or bilateral extracapsular extension
T3b Seminal vesicle invasion
T4a Extension or fixation to adjacent structures (bladder neck, rectum, Rectovesicle Fascia, external sphincter, extension to bone but not in the bone)
T4b In a nutshell it's anything beyond the T4a areas.

N0 No Lymphatic invasion
N1 Local lymphatic invasion, There is no more definition of whether there is more than one lymph node involved nor the size of the invasion.
Nx Lymphatic invasion is unknown

M0 There is no invasion in tested areas
M1a Distant lymphatic invasion is detected;
M1b Metastatic invasion to the bones
M1c Distant metastatic disease other then lymphatic invasion.
Mx Metastatic invasion is unknown

My understanding is that for these parameters, AJCC2002 and AJCC2007 are the same for prostate cancer.

For tumor sizing, David, Jon Epstein is proposing that we combine T4a with T3b. They would be designated T3b. T4 would be the only designation for anything further than T3b.

It's important to note, that doctors still use some of the older manuals in their staging practices. So we do see some T3c here are HW, but it is actually T3b in todays manual. The older T3a and T3b were combined to T3a. This changed in the AJCC2002 manual.

If anyone would like a copy of the AJCC2002 manual, send me an Email and I will send it to you. It is free online but not an easy search at the AJCC website. The AJCC 2007 manual is out, but to obtain it there is a fee. This is the only reason I don't have it. But if anyone has it, please send it to me. There are no changes in prostate cancer in it, but it would be great to keep the current manual as a reference for other cancers.

Tony
Prostate Cancer Forum Co-Moderator

Post Edited (TC-LasVegas) : 12/9/2009 2:52:01 PM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25394
   Posted 12/9/2009 4:51 PM (GMT -6)   
THanks Tony and Les for some clarification there. I had been thinking about that for awhile and wasn't sure.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys ,cath #8 33 days, Cath #9 in 35 days, 12/7/9 - Cath #10 in place


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/9/2009 4:52 PM (GMT -6)   
Les is correct in his post. Epstein is wanting to also do away with T2c and combine it to T3a

Tony
Prostate Cancer Forum Co-Moderator

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