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Thread: Cancer Stage T1c...What Does It Mean?

  1. #1
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    Cancer Stage T1c...What Does It Mean?

    My prostate cancer was classified as T1c. The DRE felt normal but my PSA was 4.58 (up from 2.7 about 18 months before). Gleason score 6. My urologist called this "moderate" and said I had an 80% chance of cure. What does all this mean? Is it stae 1, 2, 3,etc. Can someone clarify exactly what a T1c indicates? Thanks...Fred

  2. #2

    hi

    Gleason 6 means "mildly aggressive." Gleason 7 is moderately aggressive, and 8-10 are highly aggressive.

    Although you can be diagnosed with a lower Gleason than 6, in reality it's about the lowest score you see reported these days when the biopsy is positive for cancer.

    The Gleason score is comprised of two Gleason grades. My Gleason grades, for example, were 3 and 4, so my score is 7.

    I think you're wanting to translate the T1c into what most people talk about as "stage 1, 2, 3," etc. It's a little more subtle than that, but it would be in the category of stage 1. T1c means the tumor was not felt by the doctor. It was "non-palpable" and as you confirm, your DRE was normal.

    Like Gleason 6, T1c is a very common clinical stage at diagnosis.

    To break it down further, the "T" stands for "tumor". The "1" means that the tumor is present, but is not palpable and will not show up on standard imaging. The "c" means that the cancer was detected by needle biopsy. You may wonder what T1a and T1b would be, then. Those stages come from men who have some prostate tissue removed for some other reason, and the cancer is found incidentally.

    You should know, first of all, that the Gleason determined from biopsy is not always the "true" Gleason. A lot of the time, the Gleason is found to be slightly different if and when the prostate is removed and examined in total by a pathologist.

    That said, Gleason 6, T1c prostate cancer is thought to be localized, not very aggressive, and curable by a variety of primary treatments like surgery or radiation.

    You can run your numbers through the Partin tables at http://urology.jhu.edu/prostate/partintables.php to get a rough idea of your odds that the cancer is localized and therefore curable. I just did this, and it does look like your odds are 83% that the cancer is contained in the prostate, pretty much like your doctor said.

    Depending on your age and other medical history, you may want to discuss the *possibility* of active surveillance rather than immediate treatment. If you decide to be treated, you probably have a wide range of possible options:

    Surgery
    External radiation (IMRT, IGRT, proton beam)
    Brachytherapy (seeds)
    A combination of external radiation and seeds
    Cryotherapy

    and so forth.

    I highly recommend getting copy of "Dr. Patrick Walsh's Guide to Surviving Prostate Cancer" (2007 ed.) It will answer all of these questions and much more.

    If I can leave you with one last piece of advice, it is *do not rush*. This cancer has likely been developing for years, if not decades, and a few weeks to calmly assess your situation and educate yourself about all your options will not hurt, and can only help. There are pros and cons to every path open to you--make sure you have a basic grasp of those before deciding.

    Best wishes.
    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

  3. #3
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    The good news is 97% of the men diagnosed with Gleason 6 PC live long enough to die from something else, with proper treatment..I also recommend you read Dr. Walsh's book to gain a firm understanding of what is going on..
    PSA at age 55: 3.5, DRE negative.
    65: 8.5, DRE " normal", biopsy, 12 core, negative...
    66 9.0 DRE "normal", BPH, (Proscar)
    67 4.5 DRE "normal" second biopsy, negative.
    67.5 5.6, DRE "normal" U-doc worried..
    age 68, 7.0, third biopsy (June 2010) positive for cancer in 4 cores, 2 cores Gleason 6, one core Gleason 7. one core Gleason 9. RALP on Sept. 3, 2010, Positive margin, post-op PSA. 0.9, SRT , HT. Feb.2011 PSA <0.1 Oct 2011 <0.1 Feb 2012 <0.01 Sept 2012 0.8 June 2013 1.1, Casodex added, PSA 0.04 10/2013. PSA 0.32 1/14. On 6/14 PSA 0.4, "T"-5. 10/14 PSA 0.6, T-11

  4. #4
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    Thanks for the information. My concern is that I've been symptomatic for several months. Extreme urinary retention when getting up to pee during the night (not so much during the day). I'm now on Flomax and it's helping a lot, but still a problem. I've also lost about 30 lbs. over roughly the last 6 months without trying to lose weight. Also some lower abdominal pain, pelvic discomfort, etc.

  5. #5
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    Fred,

    Prostate cancer at the severity (relatively mild) that you have is frequently to highly frequently free of symptoms.
    I suggest that you talk to your docs about your symptoms since there seems a decent chance that your symptoms are caused by yet another disease or problem. Apart from possibly the urgency, and even that could well be caused by BPH that is distinct from your cancer, the other symptoms, are, in my amateur non-MD opinion, not caused by your PCa.
    age 60
    PSA 7.5
    Gleason 3+4
    HIFU June 10 Bermuda Dr Scionti
    Salvage HIFU April 11 Bermuda

  6. #6

    symptoms

    Quote Originally Posted by Fred44 View Post
    Thanks for the information. My concern is that I've been symptomatic for several months. Extreme urinary retention when getting up to pee during the night (not so much during the day). I'm now on Flomax and it's helping a lot, but still a problem. I've also lost about 30 lbs. over roughly the last 6 months without trying to lose weight. Also some lower abdominal pain, pelvic discomfort, etc.

    This could mean that you have benign enlargement and/or prostatitis *as well as* prostate cancer. I would think that the odds are stacked pretty high against you having advanced prostate cancer, and even higher against having such advanced cancer that you're having symptoms. There are no guarantees with cancer, and I'm not a doctor, but having some benign condition simultaneous with the early cancer seems more reasonable when you apply Occam's Razor (i.e. when you hear hoofbeats, think horses and not zebras, the more common explanation usually being right).


    But I understand your concern.

    I was having some weird problems that took me to see my general practitioner. It turns out they had *nothing* to do with prostate cancer. I had some mild enlargement that was probably behind getting up more to urinate at night (I was 38 at the time). But my problem did lead to a PSA test, which turned out to be a little high, which led to a referral to the urologist, and eventually, years later, a diagnosis of prostate cancer. If I had not mentioned things to my GP, I probably would not have been tested until much later in life, and it's possible that the cancer would have been systemic by then, so my hypochondria must have been a good thing, for once!

    Best wishes.
    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

  7. #7
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    No BPH...in fact my prostate is small. No prostatitis or at least no bacterial prostatitis. Urine speciman contained blood but he didn't mention any bacteria, so I assumed there's no prostate infection.
    67 Years old. Diagnosed with prostate cancer on 4/11/2011. 12 samples were taken at biopsy and 3 were positive (one 60%, one 40% and one 21%) and one borderline (PIN). Gleason score of 6. DRE normal. PSA 4.58.
    Robotic Prostatectomy 9/22/2011. All negative margins. No lymph node or kidney involvement. Cancer appears to have been contained in prostate capsule. Still Gleason 6 post-surgery. PSA 12/19/2011 < 0.1.

  8. #8
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    At this stage of the process, there is a lot of guesswork, educated guesswork, but guesswork none the less, going on. The only way to tell FOR SURE what the exact state of the cancer is is to remove it and examine the entire specimen..A Radical Prostatectomy. Radiation treatment, while equally effective in most cases, is based on educated guesswork since nobody knows FOR SURE how far your cancer has spread..You treat it, then you wait and see if the treatment was effective..
    PSA at age 55: 3.5, DRE negative.
    65: 8.5, DRE " normal", biopsy, 12 core, negative...
    66 9.0 DRE "normal", BPH, (Proscar)
    67 4.5 DRE "normal" second biopsy, negative.
    67.5 5.6, DRE "normal" U-doc worried..
    age 68, 7.0, third biopsy (June 2010) positive for cancer in 4 cores, 2 cores Gleason 6, one core Gleason 7. one core Gleason 9. RALP on Sept. 3, 2010, Positive margin, post-op PSA. 0.9, SRT , HT. Feb.2011 PSA <0.1 Oct 2011 <0.1 Feb 2012 <0.01 Sept 2012 0.8 June 2013 1.1, Casodex added, PSA 0.04 10/2013. PSA 0.32 1/14. On 6/14 PSA 0.4, "T"-5. 10/14 PSA 0.6, T-11

  9. #9
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    T1c meaning & further explanation

    Hi Fred, - The T1c means that the Tumor(s) found in examined tissue samples were obtained from a biopsy that was ordered solely because of an elevated PSA, and was not palpable on DRE nor seen on imaging, and that is ALL THAT IT MEANS. Since a Biopsy is only a "sampling" of the total Prostate, the question remaining is always, "is this a true and accurate reflection of all the Prostate Cancer (PCa) that is actually present?"

    It is not a question that is easy to answer with any certainty. It is somewhat related to the number of samples taken during the Biopsy, the more samples taken (and their distribution) increases the ratio of accuracy, but cannot ensure the CERTAINTY of the clinical biopsy results. In fact, it is safe to assume that if there is Cancer present and the Prostate is surgically removed, that the post-surgical Pathology Report, known as "Pathologic" findings as opposed to the statistically less accurate "Clinical' findings reflected in the Biopsy Pathology Report. Only post-surgical patients have the benefit of the much more accurate Pathologic findings and then ONLY following primary treatment. All other forms of treatment, where the Prostate is left in place within the body have access only to the "clinical" results which are subject to the ASSUMPTION that the Biopsy results sufficiently reflect the existing disease status, for treatment decisions to be made.

    Regardless of treatment choice, regularly scheduled PSA monitoring is necessary to ensure the continual success of the treatment rendered. The Pathologic findings, therefore, offer the greatest accuracy presently possible, in establishing the true status of the disease at the time of treatment being rendered, allowing for a more informed prognosis and secondary treatment decisions, but cannot GUARANTEE that prognosis.

    Fred, other Posters have not remarked about your statement regarding the unintentional and unexplained loss of 30 lbs. over the last few months, but I find that of concern, when coupled with the PCa diagnosis, although it may, or may not, be related. I hope this helps your understanding of this complicated subject, but if you need further clarification or have specific questions, please feel free to contact me. Good luck! - John@newPCa.org (aka) az4peaks

  10. #10
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    Quote Originally Posted by az4peaks View Post
    Hi Fred, - The T1c means that the Tumor(s) found in examined tissue samples were obtained from a biopsy that was ordered solely because of an elevated PSA, and was not palpable on DRE nor seen on imaging, and that is ALL THAT IT MEANS. Since a Biopsy is only a "sampling" of the total Prostate, the question remaining is always, "is this a true and accurate reflection of all the Prostate Cancer (PCa) that is actually present?"

    It is not a question that is easy to answer with any certainty. It is somewhat related to the number of samples taken during the Biopsy, the more samples taken (and their distribution) increases the ratio of accuracy, but cannot ensure the CERTAINTY of the clinical biopsy results. In fact, it is safe to assume that if there is Cancer present and the Prostate is surgically removed, that the post-surgical Pathology Report, known as "Pathologic" findings as opposed to the statistically less accurate "Clinical' findings reflected in the Biopsy Pathology Report. Only post-surgical patients have the benefit of the much more accurate Pathologic findings and then ONLY following primary treatment. All other forms of treatment, where the Prostate is left in place within the body have access only to the "clinical" results which are subject to the ASSUMPTION that the Biopsy results sufficiently reflect the existing disease status, for treatment decisions to be made.

    Regardless of treatment choice, regularly scheduled PSA monitoring is necessary to ensure the continual success of the treatment rendered. The Pathologic findings, therefore, offer the greatest accuracy presently possible, in establishing the true status of the disease at the time of treatment being rendered, allowing for a more informed prognosis and secondary treatment decisions, but cannot GUARANTEE that prognosis.

    Fred, other Posters have not remarked about your statement regarding the unintentional and unexplained loss of 30 lbs. over the last few months, but I find that of concern, when coupled with the PCa diagnosis, although it may, or may not, be related. I hope this helps your understanding of this complicated subject, but if you need further clarification or have specific questions, please feel free to contact me. Good luck! - John@newPCa.org (aka) az4peaks
    Not only the weight loss but other symptoms are a concern to me....the really extreme retention when getting up to pee during the night (although the Flomax has helped some with that). I don't have much of a retention problem during the day thanks to the Flomax. The penile pain after urination also concerns me. This is especially true if I pee when the urge is low and I have to kind of stretch my penis to get the flow going. Now, penile pain is nothing new to me. I've had Peyronie's since 2006 and had almost constant pain with that for about 5 years. Doctors kept telling me that Peyronie's pain for tha length of time is highly unusual (and I've talked with experts like Dr. Milam at Vanderbilt and Dr. Christine at Urology Centers of Alabama). Now I'm wondering if some of this pain may have been due to the PCa. All of this evidence seems stacked against me. Plus I just feel so bad all the time. I have found 2 local urologists who seem reliable. One has done 800 robots and has trained over 20 other docs in the da Vinci system. The other has done over 700, does about 5 a week and works as a team with another doctor. I'm trying to make a decision on one of these guys. really need help...Thanks for your reply. It helped shed new light on the situation.
    67 Years old. Diagnosed with prostate cancer on 4/11/2011. 12 samples were taken at biopsy and 3 were positive (one 60%, one 40% and one 21%) and one borderline (PIN). Gleason score of 6. DRE normal. PSA 4.58.
    Robotic Prostatectomy 9/22/2011. All negative margins. No lymph node or kidney involvement. Cancer appears to have been contained in prostate capsule. Still Gleason 6 post-surgery. PSA 12/19/2011 < 0.1.

 
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