I agree with you, but you are missing my point. A pathological staging is always more accurate than a clinical staging. But as the study above shows that 22% of high risk patients that had a negative margins still had a reoccurrance; this is not even close to being "the only sure way to know".
A good experienced doctor using partin tables, nomograms, biopsy data and scan data like color doppler and MRIS along with psa history and other tests such as PAP and PCA3 can arrive at a pretty accurate clinical staging.
The clinical staging lets you arrive at a reasonable decision on treatment options. You only have one option is you want a pathological staging. Clinical staging is not 100% accurrate, and as we have seen neither is pathological staging. For me a pathological staging comes with some pretty high costs with very little additional information or added success.
If the the clinical staging shows that the PC has escaped or is located in an inoperable
location one can choose radiation and not undergo the rigors of surgery only to have to undergo radiation. If a margin is identified, radiation can be expanded to beyond the margin to effect a kill that surgery couldn't reach. Clinical staging can also indicate when it is appropriate to begin HT or when to radiate a lymphnode.
You felt the best way to get an idea of your situation was through an invasive procedure that gave you a pathological staging and it worked for you.
I felt the best for my situation was to go through many non invasive procedures to get the best clinical staging I could, before making a decision.
I'm not saying which is best, none is 100% perfect, but you have to make the choice that you feel most comfortable. I'm mearly trying to present another informed way to get information without going through a radical invasive procedure that could have serious side affects. To many patients this would be appealing.
64 years old.
PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.
2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.
Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.
Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.
25 treatments of IMRT 6 weeks after seed implants. No side affects at all.
PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.