Treatment decisions based on clinical staging and psa

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Treatment decisions based on clinical staging and psa, clinical vs pathological staging
I was adamant about Watchful Waiting as my Clinical Stage (biopsy) T1c Gleason of 3+3 6 one core out of 13 samples taken at biopsy 18%ca My PSA went from 2.6 10/06 to 8.77 10/07 ---(the rise in PSA was an indicator that the cancer was more widespread)I was sure I had an insignificant indolent tumor and felt Robotic Radical Prostatectomy was overkill!!But decided on surgery. Dr Samadi performed my Surgery on 2/6/08 and my Pathology Stage reflects what was truly going on!!
My Gleason is now a 3+4 7
Tumor was bilateral( both sides) Stage T2c and there was cancer cells on 70% of the slides through out the prostate gland. There were clear surgical margins, ca organ confined and no seminal vesicle involvement. But the 70% ca cells on the sides is extensive and it just shows that at clinical stage (biopsy) cancer can appear to be insignificant when in actuality it is excessive. Glad I made the right decision. BCH
BCH

This is a very good point. The message is that we really dont know what kind or the volume of the cancer in your prostate until it is removed.
in 30 percent of the patient as you see in your case, the grade of the cancer is upgraded, meaning that before surgery you may have Gleason 6(3+3) and after surgery they can bump it up to Gleason 7 (3+4)
and a totally different volume.
Reason being that the biopsy is only a random sampling of your prostate and it is very much dependent on the technique of your urologist.
So it is important that if you choose watchful waiting not to loose the sight of your PSA and DRE's and if there are any changes to look into it more carefully.
The new term for this should be "active Surveillance" as opposed to watchful waiting.
Glad you are doing so well.
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