T3a or what?

User

Posted 05 Feb 2023 at 19:33

Following my nerve sparing (Neurosafe) RP 15 months ago my diagnosed T2b was upgraded to T3a by the pathologist. I have understood that means my tumor had broken through the capsule but had not invaded the seminal vessels. However, whilst stating I was locally advanced, my surgeon said the tumor had not broken through the capsule but was pushing the boundary. So, was I really a T3a? Am I in above average danger of needing SRT in the future and if so, is there a median time before the little nasties begin to show in PSA readings?

Peter

User

Posted 05 Feb 2023 at 23:34

Stick your figures in here: https://www.mskcc.org/nomograms/prostate/post-op

It will tell you risks of a recurrence.

Edited by member 05 Feb 2023 at 23:35 | Reason: Not specified

User

Posted 10 Feb 2023 at 13:42

Thanks JayneyP

Peter

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User

Posted 05 Feb 2023 at 23:34

Stick your figures in here: https://www.mskcc.org/nomograms/prostate/post-op

It will tell you risks of a recurrence.

Edited by member 05 Feb 2023 at 23:35 | Reason: Not specified

User

Posted 06 Feb 2023 at 00:11

The definition of T3A according to what I read is that the cancer has developed outside the Prostate but not spread to the Seminal Vesicles. So there may be some inconsistency between what the surgeon said and what the Pathologist saw with the benefit of close examination in the lab. The significance of this can vary from man to man and you are right that you may need SRT but I think that if and when is best something determined by an Oncologist. Cancer cells do not always proliferate in the same way or rate and some can be inactive for a time but then surge. Do you have a check up appointment soon where you could discuss your concerns or are you waiting for PSA monitoring to lead to one?

Barry

User

Posted 06 Feb 2023 at 08:07

Thanks Barry. I have 3 monthly consultations and was told at the last one recently that everything is fine (PSA 0.06). I may prepare some relevant questions for the next one. Peter

User

Posted 06 Feb 2023 at 08:55

Interesting results francij1. I did two calculations. One without extracapsular extension and one with. Both T3a. 15 year survival was 99%/98% respectively, but there was some margin on difference on likelihood of recurrance. I think I really need to get confirmation of why I was upgraded to T3a when I have my next consultation. No panic - nothing to be done about it now apart from the periodic monitoring.

Peter

User

Posted 06 Feb 2023 at 10:15

Excellent resource. Thank you. I wasn't aware of this.

User

Posted 09 Feb 2023 at 18:51

I wonder if G also plays a role in likelihood of recurrance?

Surly, for instance G9 looks to be more aggressive than G7?

Fred

User

Posted 09 Feb 2023 at 20:04

Peter

I am also T3 a. But they found spread to lymph nodes did your diagnosis mention this at all as I think this will have a possible impact in the future if they were not removed. Or have planned treatment

User

Posted 09 Feb 2023 at 20:16

No mention of spread, Nigel. But I do wonder about the contradiction between my surgeon and the pathologist. If there was spread to the lymph nodes, how and when would that have been picked up?

User

Posted 09 Feb 2023 at 20:40

Peter

in my case they noticed something in MRI scan and sent me for a PSMA PET scan

that definitely highlighted the problem

I was shown the results of that and it was amazing but equally disturbing

User

Posted 09 Feb 2023 at 20:41

As a result I don’t have the surgical option and have a HT and RT curative treatment plan

User

Posted 10 Feb 2023 at 08:12

Thanks Nigel. Hope all goes well with your treatment. Other than the tumour in the prostate, nothing else sinister showed on my MRI scan so hopefully, my N0 diagnosis was correct.

Peter

User

Posted 10 Feb 2023 at 13:37

Hi Peter. Ask for a copy of your pathology report, it might be a few pages as they dice and slice the prostate once removed and it should tell you if any lymph nodes were removed and if any were cancerous. On a positive note, they have removed the source. Best wishes.

User

Posted 10 Feb 2023 at 13:42

Thanks JayneyP

Peter

User

Posted 11 Feb 2023 at 08:19

Regarding the risk calculator, the Gleason score is the largest risk factor in a T3A.

Regarding T3A diagnosis upgrade in post op pathology, this is very common. Don't get to hung up on it. The boundary of the prostate is very thin. To be a T3A the tumour just has to be "nudging" the perimeter to get that score.

If it had invaded adjacent structures it would have been a T4 or T3B or if it had spread to lymph nodes an Nxx. Any of those will add significantly to the risk as presented by the risk nomogram.

User

Posted 11 Feb 2023 at 09:21

To be a T3A the tumour just has to be "nudging" the perimeter to get that score.

I have heard that before francij1, but everything I have read says T3a has broken through the capsule but not invaded adjacent structures. Is there a definitive text on this? I ask because I see no difference in life expectancy, or risk of recurrence after RP between a post op T2b and a post op T3a that has not breached the capsule and hence question the point of it.

Peter

User

Posted 11 Feb 2023 at 10:32

Think you are hung up on semantics!

The risk outcomes based on thousands of cases indicate there is very little difference between a t3a and a t2 (or a t1 for that matter).

The big jumps in risk come with t3a+ or high Gleason scores regardless of staging.

You can see this by playing around with the various scores on the nomogram.

That's just the nature of prostate cancer and the fact it is normally slow growing.

Edited by member 11 Feb 2023 at 10:32 | Reason: Not specified

User

Posted 11 Feb 2023 at 10:48

Think you are hung up on semantics!

Well, if I challenge you on that, I suppose I really would be!

Peter

Edited by member 11 Feb 2023 at 10:57 | Reason: Not specified

User

Posted 11 Feb 2023 at 13:00

I was a T2 before surgery and a T3a after my prostate was sliced and diced. The consultant told me that the reason for the change was that when my prostate was removed the cancer was found to be slightly bulging out but had not crossed the threshold. I was told that if I had left having surgery for 6 or more months then the cancer would have likely have broken through.

Ivan

User

Posted 11 Feb 2023 at 13:20

Thanks Ivan. Likely I was similar. I will find out for sure, if only to settle my mind.

Peter

User

Posted 11 Feb 2023 at 19:21

I think you want a scientific definition that doesn't exist. T staging, like Gleason grade, is subjective - the opinion of the person looking at the slides under a microscope or the opinion and experience of the person who does the op or whatever. Urologist, radiologist and oncologist may look at the same information and interpret it slightly differently.

John was T1a pre-op and T2c/T3 post-op because they found cancer in all sections of his prostate and it had travelled up his urethra to his bladder. Medical notes state T3 - uro said T2 🤷‍♀️

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 11 Feb 2023 at 21:23

I feel that needed difinative answers is understandable. But yet it seems it is not possible. So we need to go with the data and averages….. trouble is sometimes that Doesn’t solve the stress and worry.

Lyn is absolutely right

my mental state is I will not be defined by cancer and I am convinced the medical team will do their best and I am going to use this situation as a kick up the arse to do things I should have done years ago

User

Posted 11 Feb 2023 at 22:13

I am more curious than stressed. Think I will just thank my lucky stars that no evidence of spread exists and hope it stays that way. Thanks all.

Peter

User

Posted 03 Mar 2023 at 12:01

So now I have my post op histology report and there are a couple of things that I need some help with, please.

Extraprostatic extension present, not organ confined but specimen confined. I understand EPE but not the references to the different confinements.

Positive for periprostatic tumour extension. Is that the same as above?

Perineural invasion - present. Dr Google says this is not significant (given that all inked margins (Neurosafe) were clear. Is that so?

Any help appreciated

Peter

User

Posted 03 Mar 2023 at 15:28

Extraprostatic is bad means it's at least a t3

Specimen contained is good means it's not a T4 (I think)

Periprostatic extension means the location of the bit where it was bulging out

Perineural invasion doesn't mean a great deal from what I have read elsewhere.

If you want to understand your risks put your post op stats in the nomogram here:
https://www.mskcc.org/nomograms/prostate/post_op

Edited by member 03 Mar 2023 at 15:28 | Reason: Not specified

User

Posted 03 Mar 2023 at 15:43

Thanks francij1. I'll take the nomogram results. 87% chance of no recurrance in 10 years and 98% chance of not popping off due to PCa in 15 years. Still do not understand the 'confined' statements. Perhaps 'not organ confined' is just another way of saying extraprostatic?

Peter

User

Posted 04 Mar 2023 at 18:51

Think so but no harm in emailing the Urologists secretary and asking....

User

Posted 04 Mar 2023 at 19:14

Done some digging. It seems that non organ confined is the same as extraprostatic, I. e. cancer has spread outside the prostate. Specimen confined means negative margins and negative lymph nodes.

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