Staging your PC

johnT · Senior User Joined: 27 Apr 2009 Posts: 176

Proper staging of your individual PC is critical in determining what treatment option is best for your individual case. As Dr Stephen Stum says "Know the biology of yor Cancer before choosing a treatment option"
Most doctors don't know how to stage PC or the tests available to give you better information; that's why so many cases of PC are either over treated or have a high rate of reoccurrance.
Most patients have just a gleason score, psa and number and % of cores in which to make a decision. There is a lot more information out there to be gathered, some expensive and others fairly inexpensive.
PCA3 urine test: can indicate whether the cancer is agressive or non agressive.
PAP: Gives an indication if the PC is localized or sytemic.
MRIS: Can indicate if there is extra capsular extension.
Color Doppler Ultrasound: Can show exact location and size of tumor and indicate it's agresssiveness through blood flow to the tumor.
PSA kenitics: The tumor size can be calculated using Gleason and psa; PSA density can indicate tumor volume; PSA doubling time and PSA Velocity can indicate agressiveness and whether systemic or local.
Combidex MRI can indicate lymphnode involvement to the individual node.

Individually any of these tests can be non specific; but taken as a total can give a very good indication of the status of your PC and steer you to the treatment that is appropriate.
In my own case my original DX of a G6 small core tumor gave me every treatment option. A 2nd opinion from a prostate oncologist said there was no way I had a small G6 because of my psa kenetics. He was right and diagnosed a large G 4+3 tumor, and with a psa of 40 it was most likely systemic and not local.
The totality of all other tests; color doppler, MRIS, PAP, PCA3, PSA doubling time, combidex MRI, and how it reacted diet and to Casodex convinced us that the tumor was local and non agressive.
In each case with the limited information given on DX I would have made a wrong decision in choosing a treatment that would have cost me dearly. I believe that there are a lot of patients that are misstaged without ever knowing it. Some achieve good results none the less and others have reoccurrances or are treated for a cancer that would have never caused them any proplems.

JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

JohnRH · Regular Joined: 23 Aug 2009 Posts: 39 Location: Denver

I'm new to this, but a PSA of FORTY (not 4-point-0) is extremely high isn't it?

johnT · Senior User Joined: 27 Apr 2009 Posts: 176

40 is extremely high for a psa and usually indicates masastisis. Anything over 10 puts you in the high risk catagory. The exception to this are transition zone tumors; because they ocurr in the area in which psa is generated they create a lot of psa. They are usually non agressive and contained because they are deep inside the prostate. There have been reports of PC generating a psa of 300 in the transition zone and still being contained. Transition zone tumors are very difficult to opeate on because the urethea runs through the middle of it.
PC is very individualized so a through understanding of your own PC is imperative before a treatment is chosen.
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

JohnRH · Regular Joined: 23 Aug 2009 Posts: 39 Location: Denver

Thx for the info and quick reply.
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DX 07/2009 with Gleason 4+3, PSA 4.1, age 63 1/2.
DaVinci RRP 09/2009; Gleason 3+4; Stage pT2c, NX, MX; neg surgical margins, neg for extraprostatic extension, neg for seminal vesicle invasion; est. tumor involvement 10% of prostate

Travelingman · Posted: Sat Sep 05, 2009 6:24 pm Post subject: Staging misdiagnosed

I too, am concerned by the possibility of a misdiagnoses. As I have posted I have a PSA of 18 & my fourth biopsy found 1 core with 5% involvement & a Gleason of 3+3. My dr is reccomending radiation as he feels my cancer is very curable. My PSA went from 12 to 18 in 4 months after taking almost 3 years to go from 6 to 12. I am worried & am leaning to surgery so that the real extent of my cancer can be determined. Any thoughts posters might have would be greatly appreciated.
_________________
PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09 T2B Tumor 30% of prostate involving left & right lobes NOMX Gleason 3+4=7 Urethral Resection margins & resection surface clean Seminal vessicles clean

johnT · Senior User Joined: 27 Apr 2009 Posts: 176

Travelling man,
I would get a color doppler ultra sound. It's non invasive and can see any agressive PC that will hurt you. With this additional information you can make an informed decision. I personally think the color doppler is better than an MRIS if given by a skilled doctor.
The two best color doppler guys are Duke Bahn in Ventura CA and Fred Lee in Rocherster MI; It is definately worth the travel to see either of these doctors.
good luck.
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

Operaman · Regular Joined: 01 Jun 2009 Posts: 24

Just want to add that biopsy can give a very narrow look at what is happening. I had a negative one and spent most of a year doing other things before my positive biopsy. With a PSA of 24 before surgery it could look dire but post op psa has reached 0.0. Always seems that this is very individual.

I certainly second any procedure or activity or any Physician that might shed more light on the situation.
_________________
Bioposy March 2008 negative
March 19 2009 4+3=7 PSA 26 positive for 6 out of 12 cores
RRP May 20 2009 Path 4+3=7 tertiary 5
5% Mostly right lobe some left
Stage T3a 1 focally positive margin, clean nodes, clean vesicle, all tests for mets clean
June 22 PSA undetectable, course of Adjuvant RT completed in October with minor side effects, follow up in November

Travelingman · Posted: Tue Sep 29, 2009 7:41 am Post subject: Re: Staging your PC

[quote="johnT"]40 is extremely high for a psa and usually indicates masastisis. Anything over 10 puts you in the high risk catagory. The exception to this are transition zone tumors; because they ocurr in the area in which psa is generated they create a lot of psa. They are usually non agressive and contained because they are deep inside the prostate. There have been reports of PC generating a psa of 300 in the transition zone and still being contained. Transition zone tumors are very difficult to opeate on because the urethea runs through the middle of it.
PC is very individualized so a through understanding of your own PC is imperative before a treatment is chosen.
JohnT[/quote]

JohnT, why are Transition Zone tumors hard to operate on? Isn't the entire prostate, including the uretha that travels through the prostate, removed during surgery?
_________________
PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09 T2B Tumor 30% of prostate involving left & right lobes NOMX Gleason 3+4=7 Urethral Resection margins & resection surface clean Seminal vessicles clean

johnT · Senior User Joined: 27 Apr 2009 Posts: 176

It's my understanding that surgery doesn't remove the uretha; the bladder neck is cut and reattached, this is why incontinence occurs.
The prostate tissue around the uretha is cut away, but there is always a small amount of tissue remaining, depending on the skill of the surgeon some leave more than others. If the uretha is cut during this process it means permanent incontinence. Scardino at MSK says that transition zone tumors are very difficult to operate on and have a high failure rate.
Three specialists who deal only in PC, one oncologist and two radiologists, said that it is highly unlikely that surgery would get a clean margin around the uretha and I would end up doing radiation anyway.
There is not a lot of information out there on transition zone tumors.
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

JerryB · Regular Joined: 13 Jul 2009 Posts: 43 Location: UK

I may have completely misunderstood things, but I get the impression that the whole prostate is removed, including the urethra within. The part of the urethra that was below the prostate is then pulled towards the bladder neck and attached.

My comment is based on watching the attached video. It's a hour long and doesn't spare the punches, but it really does give a good idea of what robotic surgery involves, and the skill of the surgeons. http://www.or-live.com/jeffersonhospital/1285/event/rnh.cfm

Jeremy
_________________
Age - 67
PSA – 7.8 ug/L. in February 2009.
Gleason – 7 (4+3). T stage – 2b. Prostate size - 52 cc
July 2009 - ADT for 3 months to shrink prostate.
September 2009 - decided on HIFU. Scheduled for 30th October 2009.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

JerryB is correct. Walsh's book explains the procedure. The urethra that is within the prostate comes out with the prostate. The bladder is pulled down and attached to the other end of the urethra in a tricky bit of surgery called anastomosis. The catheter maintains continuity while the anastomosis heals around it.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

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