What is considered a high tumor volume?

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compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 2/2/2010 10:00 PM (GMT -6)   
That's my question.
 
Also, is it significant in terms of prognosis?
 
I noticed the Sloan-Kettering nomographs do not include that in their post surgery calculations.
 
Mel
63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.  
History of BPH/prostatitis. PCA-3 test: 75.9 (bad news, guaranteeing I have to do....): Biopsy on 11/30/09. Result of biopsy:

5 out of 12 cores positive. Gleason 4+3. More specifically: 2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Surgery with Dr. Menon at Ford Hospital,  1/26/10. He says all looked good. Spared nerves. Awaiting pathology report, set for 2/2/10.

Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland.

Lymph Nodes: Clear

Perineural Invasion: yes. Seminal Vessical Involvement: No

Extraprostatic Extension: yes

Positive Margin: Yes-- focal-- 1 spot .5mm

Final Weight is 52.7 gms

Incontinence: just joined that club-- definite leaks-- my guess is 1 pad during the day -- at night??? First night tonight!

 

 

 


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 2/2/2010 10:15 PM (GMT -6)   
While this doesn't answer my question per se, I did find this interesting article:
 
Tumor Volume and Prostate Cancer
by William J. Catalona, MD

Even when the pathology report after a radical prostatectomy states that it looks like all of the cancer was confined to the prostate gland, some percentage of men have a recurrence of the cancer at a later date.

In these instances, although it looks as if the cancer is organ-confined; in fact, some cancer cells have spilled out but they can't be measured or detected at the time of surgery.

Being able to predict whether the cancer might recur at a later date, in instances when it looks as if the cancer was confined to the prostate gland, is a goal of follow-up treatment and practices.

One factor to help in making the predictions regarding non-recurrence or recurrence is the tumor volume, which is measured as the percentage of the prostate involved by the tumor.

My research group completed a study on my 3,000 plus radical prostatectomy patients to see if tumor volume can predict the frequency of recurrence of the cancer in those patients whose pathology reports showed the cancer to be confined to the organ.

We found that the tumor volume estimate is an independent predictor of possible cancer progression (recurrence) after a radical prostatectomy (RP) in patients with organ-confined prostate cancer.

An independent predictor means that we can look at that tumor volume and make a prediction without considering any other factors or conditions.


"Predicting whether cancer might recur is a goal of follow-up practices."

In our studies, we found the following:

The 5-year progression-free survival rates were as follows
94% for men who had less than a 10% tumor volume; 91% for men who had a 10-20% tumor volume; 85% for a 21- 30% tumor volume; and 79% for over 30% tumor volume.

The 10-year progression-free survival rates were as follows:
88% for men who had less than a 10% tumor volume; 86% for men who has a 10-20 tumor volume; 79% for those who had a 21-30% tumor volume and 59% for over 30% tumor volume.

Clearly, tumor volume is a predicator of non-recurrence or recurrence of prostate cancer after the prostate is removed.

At the present, this tumor volume information does not make a practical difference in post RP treatment except to ensure that men are vigilant about coming back for their follow-up visits.

Some men want to forget that they had cancer and are afraid of getting follow-up PSA tests.

However, if there is a recurrence, salvage radiotherapy can sometimes cure the cancer if one does not wait until the PSA has risen to a high level.

Accordingly, I tell my patients the good news is that their tumor appears to be completely contained within the prostate gland; however, I add that it was a large-volume tumor and we know from past experience that they have a higher risk for recurrence.


63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.  
History of BPH/prostatitis. PCA-3 test: 75.9 (bad news, guaranteeing I have to do....): Biopsy on 11/30/09. Result of biopsy:

5 out of 12 cores positive. Gleason 4+3. More specifically: 2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Surgery with Dr. Menon at Ford Hospital,  1/26/10. He says all looked good. Spared nerves. Awaiting pathology report, set for 2/2/10.

Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland.

Lymph Nodes: Clear

Perineural Invasion: yes. Seminal Vessical Involvement: No

Extraprostatic Extension: yes

Positive Margin: Yes-- focal-- 1 spot .5mm

Final Weight is 52.7 gms

Incontinence: just joined that club-- definite leaks-- my guess is 1 pad during the day -- at night??? First night tonight!

 

 

 


Aprilsunny
New Member


Date Joined Jan 2010
Total Posts : 15
   Posted 2/2/2010 11:42 PM (GMT -6)   
Mel,

Sorry that your pathology report proved so worrisome for you. Searching PubMed, I found this article, dating from Jan.18, 2010, which differs a little from Dr. Catalona's study:

Tumor Percent Involvement Predicts Prostate Specific Antigen Recurrence After Radical Prostatectomy Only in Men With Smaller Prostate.

Best wishes to you, and hoping for only negative PSA's.

Regards, AS
Brief History (Husband)

Age - 60

4th of 5 brothers. Brother 3 died at 65 of PCa, brother 2 is five-year survivor of PCa, (brother 1 died at 61 of heart attack). So far brother 5 is okay.

PSA - October 2009 - 6.4
Biopsy - November 17, 2009 - Gleason 4+3=7 DRE Normal Stage T1C
open RP - January 14, 2010

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