Regarding; Am I T2b or T1c my URO

just explained to me via the telephone "I didn't listen well the first time he explained it" (his ass is so fired)...

and he said,

Clinically defined I was staged at a T1c as he did not find the cancer via DRE or via sonogram but

that did not make any difference as the bioposy showed more then 50% of the right lobe (5 of the 6 samples taken in the right lobe) indicated cancer at various %, therefore I am Pathologically staged as a T2b... and that was the important staging at this point ( the clinical staging is now a moot point) .

He further indicated that the staging of course could go up higher after the surgery if the pathological analysis of the prostate shows a higher level of cancer presence..

So there you have it. I was lectured and spoken down too..... not like the diagnosis is stressful enough.

We fired our first urologist. There are too many other uro's to be treated poorly especially w/ all the stress you are already going through! Our's wouldn't see hubby for three months if he went and got a second opinion. Big red flag, so he got fired.

Bensam's Uro said...
Clinically defined I was staged at a T1c as he did not find the cancer via DRE or via sonogram

Exactly! Your clinical stage is T1c. That is very good, because it keeps you in the low risk category.

Bensam's Uro said...
but that did not make any difference as the biopsy showed more then 50% of the right lobe (5 of the 6 samples taken in the right lobe) indicated cancer at various %, therefore I am Pathologically staged as a T2b... and that was the important staging at this point ( the clinical staging is now a moot point) .

No, no, no. The clinical staging is used for risk stratification purposes. Your clinical risk level helps define which therapies are most appropriate for you. The clinical staging is not affected by the biopsy findings. Pathological re-staging is done after surgery only, not after a biopsy. You have not had surgery, so you have no pathological staging, only a clinical stage. You are not at a higher risk level because positive cores were found throughout the right lobe. They have to be "clinically apparent" - seen or felt - to raise your risk level.

You don't have to trust me. Read it for yourself:
Prostate Cancer Staging

Notice note 1 on the bottom. It states: "Tumor found in one or both lobes by needle biopsy, but not palpable or reliably visible by imaging, is classified as T1c"

- Allen

In some cases (and I am not grouping all docs into this category) I think they get the GOD mentality and we are supposed to just blindly accept anything they say, do no research and never question. It makes me so mad. The nurse practitioner (after my two pages of questions) assumed I was a nurse today. I said no, I research everything I can get my hands on about this, to be informed. She looked shocked. Is this something most people don't do? She wasn't offended by it by the way, but assumed a "regular" patient wouldn't have enough knowledge on the subject to ask the questions I asked, that it would have to be someone in the medical field.

While we're ragging on doctors (my apologies to the large percentage of great medical pros) I had an appointment with an oncologist that my urologist had recommended after my diagnosis when I told him I wanted a second opinion.

The oncologist told me in no uncertain terms that I didn't qualify for brachytherapy since my biopsy showed cancer in "both lobes." He said it with such certainty and wanted to know why I was scared of surgery (which I never mentioned) and I ended up horrified that I had somehow missed the fact that brachy wasn't a possibility for me.

Interestingly, I see this guy all the time since we're at the same gym. He obviously doesn't remember me and I have this ongoing fantasy that I confront him in the locker room and tell him in fact I did have brachytherapy and then make him recite my PSA scores back to me.

BenSam, congrats to you for firing the guy - as discussed in another thread, great example of being your own best advocate - versus simply 'bowing down' to the 'god-like' that Miki also stated well.

TA you nailed it again - succinctly, factual, solid and to the point.

Prato, I've had similar reactions from a number of medical professionals I've come across - albeit for the most part they were very impressed with my level of awareness. For example early on when I was meeting with some of the PCa medicalists, they were blown away that I not only knew about things like the Grimm report, but that I actually bought it and was versed in it.

I share Ben Sam's confusion. The clinical staging process doesn't seem logical to me. 2 patients with identical tumors could end up with different staging depending on whether or not any imaging was done.

Patient A has positive biopsy results after negative DRE and high PSA, and has no imaging done - his stage could be considered T1C.

Patient B gets a biopsy after negative DRE, high PSA and mp MRI which shows a tumor involving both lobes - his stage is T2C. If patient B had not done the MRI, he could have been lower stage T1C.

So the logical but nonsensical conclusion is that you should not have any imaging done so that you can end up with a more favorable clinical staging.