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T3a or what?

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User
Posted 05 Feb 2023 at 20:33

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 06 Feb 2023 at 00:34

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

It will tell you risks of a recurrence.

Edited by member 06 Feb 2023 at 00:35  | Reason: Not specified

User
Posted 10 Feb 2023 at 14:42

Thanks JayneyP

Peter

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User
Posted 06 Feb 2023 at 00:34

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

It will tell you risks of a recurrence.

Edited by member 06 Feb 2023 at 00:35  | Reason: Not specified

User
Posted 06 Feb 2023 at 01:11
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 09:07

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 09:55

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 11:15

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

User
Posted 09 Feb 2023 at 19:51

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 21:04

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 

N

User
Posted 09 Feb 2023 at 21:16

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 21:40

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 21:41

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 09:12

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 14:37

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 14:42

Thanks JayneyP

Peter

User
Posted 11 Feb 2023 at 09:19
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 10:21

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 11:32

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 11:32  | Reason: Not specified

User
Posted 11 Feb 2023 at 11:48

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 11:57  | Reason: Not specified

User
Posted 11 Feb 2023 at 14:00

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 14:20

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

Peter

 
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