Prostate staging

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Maforce

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Say you palpate a prostate nodule in <1/2 of one lobe but biopsy revealed malignancy in both lobes, would this be cT2a or would it be T2c at this point? thanks
 
Technically, you cannot use biopsy results for clinical staging per AJCC. However, you may use U/S to do so if warranted. Barring U/S, your patient is stage cT2a.

However, you may still use the 'upstaging' from biopsy to treat more aggressively, particularly if >= 50% of cores are positive.
 
Thank you for the input...can we call it pT2c then?
 
How about ECE or SV invasion by MRI? Is that T3a and T3b by clinical staging?
 
Not sure what AJCC says, but I think it is, based on the MRI prostate literature. They are calling it T3 if they see it on MR.
 
Not sure what AJCC says, but I think it is, based on the MRI prostate literature. They are calling it T3 if they see it on MR.

as they should. seems silly to wait for a prostate specimen to call T3 disease given what we know about the role of adjuvant treatment in that setting. I really hope AJCC would allow for that
 
On last reading, I believe AJCC manual suggests that at this time MRI lacks the specificity for ece detection/SV invasion and it is not part of staging. (I may stand corrected) That being said a T3b is hard to imagine to be detected on clinical examine. I take that back - unpleasant to image as we have a urologic oncologist who basically has the patient grab his own ankles for a DRE and swears he can detect SV involvemnet. Clearly this is a fuzzy area with big implications for dose to entire SV and maybe even push to treat lymphnodes in otherwise lower risk patients.
 
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