lymph node question

During my RRP 22 lymph nodes were removed. I was not aware that the doctor was going to remove them.  Is it normal to have lymph nodes removed during an RRP?  What problems down the road do you think I might have from having so many lymph nodes removed?

I believe that one of the benefits of having an open RRP is the ability to remove the lymph nodes. It is more difficult to obtain the lymph nodes during the DaVinci. My father had lymph nodes removed and one was positive, therefore, we were very grateful to know that he did have involvement beyond the prostate and were able to treat aggressively. His margins were clear with the exception of one focally positive margin, therefore, we wouldn't have suspected ln involvement had the nodes not been removed. In addition his MRI was negative for ln involvement prior to his procedure, so it was quite the shock. In my personal opinion, I would prefer to have them removed and have the piece of mind that they were negative. The only way to really know is by removing the ln. So, you probably had more ln removed than most, but hopefully it was worth it! Best to you in your recovery!

In my current state of shock and search for knowledge, a leading "open" urological surgeon and a colleague of his who is an oncologist and gastro-instest specialist told me that "a trend in the literature and practice" is NOT to touch the lymph nodes if PSAs are UNDER 10.5....since I basically know nothing, others in this forum can perhaps enlighten us....

  ..at first my Dr. was unsure if he would take any of mine or not, said his normal cut-off(no pun intended) was at the G6 mark, with me being a G7 he went ahead and took some of mine closet to the prostate( I think it was five too)....that is why I was sent home with the JP drain still in place he told me....I'm glad he checked them out...

I can't speak for everyone but I personally knew prior to surgery that I was going to have a lymph node disection and I agreed to it. Thank goodness I did because that was the only way I know that they could have found the cancer. When you are dealing with an enemy like cancer I think you should use all measures available to find exactly where it is. To me it is one of those things to where if your doctor did not do it and a year down the road you cancer has spread you will wonder why he didn't do it. To me a lymph node disection is minor compared to not doing it. Obviously for me it meant life and death so I have a different opinion than most.

Please stay in touch

peace and love

Dale

Navy,
22 seems like a lot. But I am not surprised. I am amazed when lymph nodes, at least in the pelvic region, are NOT dissected. But some surgeons don't do it at all. In fact, some big name surgeons don't do it and many big name surgeons always do it. I am not sure why that is. But there are enough studies showing that lymph node disection is an important part of surgical prostatectomy. Any involvement could change the post operative treatment options drastically. My surgeon removed 10 pelvic lymph nodes.

There is also some evidence that removing additional lymph nodes in stage III and IV cases has a postive effect on results. Dr. Snuffy Myers writes that he was diagnosed stage IV and had what he called a Lymphectomy even though his prostate was inoperable. I can see the logic to this if bone mets are not present. Myers has written well known books and essays on it, and he is doing well ten years later. I wonder how many stage III and stage IV guys here that did not have any removed might want to consider asking about doing a lymphectomy?

My surgeon just does this in his practice. I think if I were to do this all over again (once is enough) knowing what I do now, I would request that the doctor did remove at least the pelvic region nodes as mine did. It hasn't caused me any issues, and it was good to know, especially in my case, that the nodes were clean.

Tony

Thanks for all the replies.

Does anyone understand the effect on the lymph system when lymph nodes are removed from it ?

- John

I was quite adament that lymph nodes NOT be removed during surgery, with concern over lymphadema. Our doctor stated unequivocally that there is no need to remove lymph nodes, as PSA says it all.  With prostate cancer, if you have significant PSA after surgery then you still have a problem.  You do not need to remove lymph nodes to find out, like with other cancers.  That being said, we found out that there was a lymph node removed during B's surgery.  Turns out, there was one in the fatty tissue, not recognized as such until it was removed with the prostate.  So be it.  I had an aunt with breast cancer who suffered greatly from from lymphadema after having lymph glands removed.  I would avoid it if at all possible.

I would say, check again, regarding the removal of lymph nodes. They used to do it, but protocol is changing now. Bear in mind that the lymph system is still not well understood. My sister, the RN nurse supervisior and teacher at a major hospital informs me that medical community is recognizing the fact that the lymph system is part of what fights cancer in the human body. And I will state again that Dr. Thomas Ahlering, the top urologist at UC Irvine, where they developed the Da Vinci equipment for robotic assisted surgery, does not routinely remove lymph nodes.