Prostate staging

[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

 

[Gfunk6]

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.

 

[Maforce]

Thank you for the input...can we call it pT2c then?

 

[Gfunk6]

Thank you for the input...can we call it pT2c then?

No. Pathologic staging requires a prostatectomy. Biopsies don't count.

 

[Palex80]

No. Pathologic staging requires a prostatectomy. Biopsies don't count.

True. TUR-Ps dont count either. There is only cT1a-b as well, no pT1a-b.

 

[Ursus Martimus]

How about ECE or SV invasion by MRI? Is that T3a and T3b by clinical staging?

 

[deleted4401]

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.

 

[medgator]

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

 

[Ursus Martimus]

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.