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Posted 6/4/2012 10:28 PM (GMT 0)
Hello,

My husband has just be diagnosed with Prostate Canser.

His PSA level was 6.2 and they did a DRE so was sent to the constuitant for more tests.

The did another DRE and confirmed that they could feel (and I can't remember exactly what they said but...) either nodules or roughness or something!! and then did a biopsy. The biopsy found cancer cells on both the left and right side.

They have said he is at stage T1c.  Now I have been having a read of the info and according to what I have read if they can feel a change in the prostate it should be a T2 at least.!!

Do you think I am worring overly or is the4re a possibility they got it wrong? 

Posted 6/4/2012 10:51 PM (GMT 0)
Welcome to the Forum, sorry for the reason you are here.

A T1c or T2c isn't really that different. I don't see anywhere that it involves whether a dre felt something, as that is an observation by the uro, seperate from the lab inspection and staging done on the biopsy. From what I can tell, the difference from a 1c and 2 c is the 1 c showed cancer cells with an elevated psa, and 2c adds to that by showing in both lobes Not a big difference overall, but you may want to discuss with the uro who did the biopsy all the details. This is just one item in the list of things that must be considered when deciding on a treatment plan.

From the cancer.gov website, their scaling and staging guidelines:

Clinical
TX -- Primary tumor cannot be assessed
T0 -- No evidence of primary tumor
T1 -- Cannot detect tumor with imaging tests
T1a -- Less than 5 percent of the prostate is affected by the tumor
T1b -- More than 5 percent of the prostate is affected by the tumor
T1c -- Tumor identified by needle biopsy, PSA elevated
T2 -- Tumor confined within prostate
T2a -- Tumor affects one-half of one lobe or less
T2b -- Tumor affects more than one-half of one lobe but not both lobes
T2c -- Tumor affects both lobes
T3 -- Tumor extends through the prostate capsule
T3a -- Tumor extends beyond the prostate capsule
T3b -- Tumor invades seminal vesicle(s)
T4 -- Tumor is fixed or invades surrounding areas, such as the bladder neck, external sphincter, rectum, levator muscles, and/or pelvic wall

Pathologic
pT2 -- Tumor confined to the prostate
pT2a -- Tumor affects one-half of one lobe or less
pT2b -- Tumor affects more than one-half of one lobe but not both lobes
pT2c -- Tumor affects both lobes
pT3 -- Tumor extends beyond the prostate
pT3a -- Tumor extends beyond the prostate
pT3b -- Tumor invades seminal vesicle(s)
pT4 -- Tumor invades the bladder, rectum
Posted 6/5/2012 12:21 AM (GMT 0)
That's great info James. The staging comes from the biopsy slides and is determined by a pathologist not the Uro. I don't think it takes into account the DRE. Given the PSA number I'd think T1C is possible.

But you could get a second opinion on the biopsy slides if you want to confirm. In either case, T2 or T1 you're still looking at about the same first treatment options - surgery or radiation. The real question now is whether or not it is confined to the prostate or not. That is a bigger deal.

You will likely want to get that point cleared up with your doctor but I wouldn't be too concerned about a huge mistake. I would suggest that you get at least one second opinion before moving forward to a treatment plan.
Posted 6/5/2012 12:52 AM (GMT 0)
The important thing here is that there are two different "staging" values.

One is Clinical,the first part of what James quoted, and determined by tests and observation. It is pretty subjective, since there is only scan data and biopsy slides to work with. I was told I was a T1c by one doctor, T2a by another, all based on the same data. Because they could not see/feel the back side of the capsule from what was done, they could not know I was really a T3a. There were additional tests that I might have done if I had known about them, which might have revealed this, but having decided to have surgery, it was a moot point.

The second, which is in the grouping "pathologic" in James' post, is sometimes preceeded with a p, as in pT2a. This is determined by looking at slides after surgery. If you elect radiation or some other non-sugical treatment, you will not get this type of staging.

When I asked about this later, an oncologist told me that there were really only two "clinical" stagings to worry about - T1/T2 vs T3/T4.

 

Posted 6/5/2012 1:21 AM (GMT 0)
Wifeywife,

Welcome to HealingWell. I'm sorry you have to deal with this, but this forum is a great source of information and support. It's good that you're here.

You've already received excellent information about staging. The other relevant piece of information is the Gleason score. If you post that, along with your husband's age, we can give you better information on his likely choices.

Good luck, and hang in there. Chances are excellent that he'll be fine.

Jonathan
Posted 6/5/2012 1:39 AM (GMT 0)
Jonathan makes an important point that I neglected to put in the previous post.

My biopsy Gleason score of 4+4 and location/% was, as explained to me, much more important than the t1/t2 in selecting a treatment path. If I  had a clinical t3/t4 (the bone scan / CT scan are for this determination), the amount of metastasis would have been an important factor.

I guess what I am saying is that in my case, with two well known docs, I got two different stagings, and they were both wrong based on post-surgery pathology. At this point in your journey, I would worry if anyone says T3/T4, but otherwise (T1/T2), it is an educated guess.

Posted 6/5/2012 4:48 AM (GMT 0)
I'm new here myself, though not new to prostate cancer. I've seen a lot of thoughtful discussion, advice, and support on this site. T1 or T2 is good news (ok, I lied, --the better side of bad news), but even a higher staging isn't necessarily awful. I was staged T3b 10 years ago with a PSA of 9 and with a palpable DRE and am still doing fine. Post your questions, fears, concerns here and folks will help.

Post Edited (Bohemond) : 6/4/2012 10:54:05 PM (GMT-6)

Posted 6/5/2012 11:52 AM (GMT 0)
Hi and welcome,

I would agree that there are three most-important pieces information which describe your husband's case at this early phase: PSA, DRE, and Gleason sum.

For the vast majority of cases, including your husband's, DRE is reported within the "staging."  DRE is an opinion, and so it is not uncommon for there to be some variation for the cases that are "close calls" on whether the surface of the prostate feels rough or not.

With regard to DRE, T1c simply means the prostate felt normal to one doctor. T2 means that in the opinion of the other doctor there was some roughness. T2a means a little roughness, T2b means more roughness but still only on one side, and T2c means at least some roughness on both sides.

It's also important to know that a doctor only feels one side of the prostate during a DRE exam; he/she can not feel 360-degrees around.

The fourth most-important piece of information is not often available at the time of diagnosis, and that is how the case may be changing (or not) over TIME. Most prostate cancers grow very slowly.  If your husband does indeed have a palpable tumor (staged T2, based on DRE), then treatment may indeed be appropriate; if he doesn't, then maybe not (depends on other case characteristics, including how it changes over time).

Best wishes...

edit:  fixed typo/wording

Post Edited (Casey59) : 6/5/2012 10:00:15 AM (GMT-6)

Posted 6/5/2012 1:05 PM (GMT 0)
Casey, for future bookmarking and a resource to be used in posts, can you tell me where I can find a chart of the 'degrees of roughness or nodules, etc' from DRE's as it is put into the scaling chart of t1c or t2c, etc. I would like to be able to use that DRE exam result with the staging one , if it is available online.
Posted 6/5/2012 2:41 PM (GMT 0)

I agree, the Gleason score is what the pathologist use to measure the pattern of the Cancer cells to assess the grade or degree of aggressiveness, which usually determines the next action to take.  

Jonathan said...
Wifeywife,

Welcome to HealingWell. I'm sorry you have to deal with this, but this forum is a great source of information and support. It's good that you're here.

You've already received excellent information about staging. The other relevant piece of information is the Gleason score. If you post that, along with your husband's age, we can give you better information on his likely choices.

Good luck, and hang in there. Chances are excellent that he'll be fine.

Jonathan

Posted 6/5/2012 3:11 PM (GMT 0)

James, in response to your question (and I hope that Wifeywife's thread doesn't go down a sidebar rathole; no need to reply to me unless you have further question)...

I did consciously decide to keep it simple in my reply to Wifeywife (sometimes that approach is best for newcomers).  I think the descriptions are available at many of the better web sites, but for your reference I very much like the detailed, yet layman's language, used at The "New" Prostate Cancer Infolink web site, and at THIS link the Sitemaster describes the multiple (no wonder there is confusion) PC staging systems in use today.  I've see other sites describe nodule sizes (1.5 cm threshold of "roughness", as described HERE) as the key differentiator between T2a and T2b, but the examining physician is not going to use a micrometer, so the judgement "opinion" is even more necessary; that's why I think the descriptions have migrated to how they are described below.

Here's a copy/paste from the link I provided about the T2 details; it's a bit wordy, but he is in "explain-mode" (underlining added by me):


Stage T2a disease — When a physician says a patient has stage T2a disease, it means the physician can feel the tumor in not more than half of one side (one lobe) of the prostate when he does a physical examination with his finger (a digital rectal examination or DRE). The physician calls this a “palpable” tumor. Stage 2a disease may also be identified when the physician can clearly see what appears to be a tumor in not more than one half of one lobe of the prostate as a result of some type of imaging test (e.g., an ultrasound or an MRI image). Stage T2a disease is very similar to stage B1 disease in the Jewett-Whitmore system of staging.

Stage T2b disease — Like stage T2a disease, stage T2b disease is also something the physician can feel when he does a digital rectal examination. In this case, however, more than half of one lobe (but not both lobes) of the prostate must have palpable tumor which the doctor can feel. Stage 2b disease may also be identified when the physician can clearly see what appears to be a tumor or tumors in both halves of one lobe of the prostate as a result of some type of imaging test (e.g., an ultrasound or an MRI image). Again, stage T2b disease is very like stage B2 disease in the older Jewett-Whitmore system.

Stage T2c disease — Stage T2c disease is similar to the other two stage T2 disease described above, except that in this stage the doctor is able to feel palpable tumor in both sides or lobes of the prostate, the left side and the right side or see such a tumor or tumors using an imaging test.

hope this helps...

edit:  wording

Post Edited (Casey59) : 6/5/2012 10:13:23 AM (GMT-6)

Posted 6/5/2012 4:28 PM (GMT 0)
Hello,

Thank you for all your very useful replies.

My husband had a gleason score of 6. He is 54. The biopsy found 20% on the left side and 2% on the right side.

I was concerned mainly because when we spoke to the Nurse that did the DRA she said she could feel lumps or nodules or something (can't remember her exact words) and she was surprised that our GP got it right as they normally get it all wrong.

What is the opinion of the best results. Low dose Bracheytherapy or Surgery?

Thank you
Posted 6/6/2012 12:40 PM (GMT 0)
Any thoughts on best treatments please?

Thank you
Posted 6/6/2012 1:29 PM (GMT 0)
You can read what I went through by clicking on the link in my signature. Take your time though and get opinions from several of the best doctors you can find. I am very happy with my choice, but looking back I still wonder if I should have had any treatment at all.
Posted 6/6/2012 2:27 PM (GMT 0)
No one here should tell you what a 'best treatment' is. We can offer our experience with what we did, but there is no medical advice allowed on the board.

I suggest that you make a number of "second opinion" appointments with at least a surgeon and Radiation Oncologist. All of them will be slanted to their type of practice, so you will have to sort out the fact for yourself.

I wanted to do seeds, but was refused as "too far along".

I consulted with MD Anderson for Proton RT, but was told that it was not appropriate for me (by MD Anderson), and my insurance felt it did not offer any advantage over standard IGRT that was locally available, so they would not cover it.

IGRT as a primary treatment was offered, but the best % success for my case by any RO was given as 70% (some offered less).

I elected surgery (DaVinci), but post-op pathology was such that we did immediate adjuvant IGRT  (G4+5, EPE, pos. margins).

At one year post IGRT my PSA reached the accepted BCR level, and is still rising, so there will be some more treatment in the immediate future. I'll know more about that tomorrow.

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