Wotan said...
**-"If no mets to Seminal Vesc- & lymph, PSA is good--after the DaVinci surgery a 'Regional stage 3' it is coded as a "pT3a"... Has just as much as a good prognosis....as a stage 1 or 2...!"
He said.."the dangerous thing....is when it gets to the seminal vesicles !"....THAT kinda "stage 3"...is different !
Soo-- just curious...if anyone....was aware of this.... but others...Didya know..? Again....I had "No clue"
Quote edited for readability (forgive me please)... Yes, I for one was already aware of the difference between T3a and T3b... In fact the T3b thing and SVI were used by my doc's to instill a sense of urgency into my treatment schedule.
BUT ANYWAY... there's something I've observed. I'm sure that some here will refute me on this, as it seems I tend to be wrong more than many others, but it's just something I've noted reading the sigs of others guys at various stages of treatment and potential recurrence.
The guys with T3a seem to be more likely to come back with a recurrence some years later, or perhaps come out of surgery with PSA's that never actually hits the level of being 'undetectable'. As I understand it, T3a means that there was extraprostatic extension but the cancer has not invaded the seminal vesicles. So the horses have left the barn but have not yet begun grazing in the neighbor's pasture.
The T3b guys, like me, generally go right into hormone deprivation therapy and adjuvant radiation. We come out of surgery maybe with a low PSA but the doc tells us it won't stay that way, that we should get it treated while it's still localized in the area of the prostate and before it moves on to the bones or lymphatic system. The horses are already in the neighbor's front yard and are headed toward town.
I suspect - and of course, just thinking and anyone who knows FOR SURE is welcome to dispute my surmising... that the T3a tumors may be more often found at the apex of the prostate, closer to the penis end of things, where it is easy to be found by a finger poke or some random needle jabs... but is more difficult to excise without cutting into adjacent tissues, thereby leaving what is known as a "positive surgical margin".
If and when further treatment is needed, and often times in these cases, it is... that's the first place they shoot for. But alas, all the cutting and scraping may have allowed some of the cells to escape and go into circulation.
On the other hand, when the primary tumor is at the opposite end of the prostate, at the base directly under the bladder, it is often found (or so it seems) to have escaped into the nearest recesses... the SV's or the bladder neck. Typically the SV's come out with RP, so I'm guessing it's just another cut. And the bladder neck can be repaired or the resulting incontinence dealt with if that also must be cut away.
The downside of a tumor confined to the base is that DRE's miss it and so do ultrasound biopsies. It is tucked away from easy rectal access and may be more difficult to find. Hence it is free to grow until someone gets the great idea to look beyond the lower third of the prostate.
My urologist informed me that he "had to remove a lot of tissue" but that resulted in, as he said, "negative nodes and negative margins". Of course, there was a lot of other damage, but I can live with that (literally!) And when I asked my RO about
targeting he said he believed the cancer was confined to the prostate bed. I'm not sure how true that was, but for now it's looking like he got everything... or so I hope.
So I will conclude with the following summary...
pT3a, often apical, easy to diagnose, difficult to remove, more likely to recur
pT3b, often at the base, difficult to diagnose, easier to remove, more likely resolved
I would appreciate any
constructive input regarding these observations. Has anyone noted anything similar, or am I way off base here? Just curious. I'm sure there are individual exceptions, but what I've observed
in general leads me to think there may be something to this.
Thank you for your courtesy and civility in your replies.