Another question about surgery - lymph nodes

My doctor removed a total of 14 lymph nodes. He took 4 paraprostatic and 10 pelvic. However the same physician did my brothers surgery and a total of only 6 were taken all from the right pelvis (brother had right side prostate involvement). What I understand is that it really isn’t the easiest thing to do. I also understand that some folks have lymph edema of the lower extremities post surgery I assume from disrupting the lymph drainage system. So I guess that you can only take so much tissue. To answer your question Not only did I not ask about the surgical margin rate I did not even think to ask if lymph node harvesting would be a component of my surgery. I went in understanding the right side would be widely excised. I went in with the understanding that the surgeon would do all he could to “get it all” which actually is a way of saying trying to avoid any possibility of a positive margin. It worked for me but failed in my brother case. I mostly wanted to get discussion started with my original question because of the evidence that was in the two referenced articles. Thanks very much for your follow-up question. I’ll have another thing to ponder while I’m on my tractor this afternoon. Hero

A study coming out of Germany and Holland last year found that there are two distinct paths prostate ca takes when spreading to the lymphnodes. Surgical removal only samples one of these paths so there is a 50%chance that lymph node PC will be detected by surgical removal. This is especially important if there is seminal vesicle involvement.
JohnT

They took & examined 12 lymph nodes distributed on both sides from me - the small channels were involved, but the nodes were still clean.
There was no question, they just said that was what they would be doing.

I had 13 removed and 2 on the left side tested positive and 1 on the right side. Since my surgery was aborted I have no idea where else my cancer may be but I am living large everyday so I guess ADT3 and radiation did the trick. Well for now anyway.

peace to all
dale

As an observer of this phenomenon on patients and asking a surgeon doc at a seminar what he did for surgeries in general with an answer I could not believe, I would say "question everything and all the time" with PCa, based upon the lack of knowledge/errors of many uro-docs(whom are surgeons too) just on psa velocity, doubling time, biopsy issues,(errors like) prescribing Lupron before giving casodex especially to higher risk patients (because of 'flare' issues), and other less than definitive screenings and some not even running nomograms or Partin tables on patients(the mistakes, errors, lack of propriety)....perhaps you might reach a similar conclusion, do they know exactly what they are doing or are they doing harm either not knowingly or perhaps knowingly playing gineau pig with your lymphnode testings ?(how dark to mention). So, how good are they, as a layperson can you really know? You can think about it for yourselves. I know it is rough to contemplate, you see these variations herein add to them alot of guys never get sampled, what does Dr. Walsh probably say about sampling I would value his opinions as one the better experts in this field? (been long while since I read his book)  Surely someone here can quote him or his thoughts on this protocol...I thought all patients were supposed to get some type of lymphnode(s) sampled before removing the gland..that was the way I remember hearing it back in 2002-2003.

Post Edited (zufus) : 3/21/2010 10:17:01 AM (GMT-6)

Zufus,
To brutally summarize from a few pages in Walsh's book (June 2007, 2nd ed. p.273-276), he tells of the process of an early (extra) staging surgery for removal and testing of lymph nodes around the bladder, and how that is not done as much now, only for palpable tumors with Gleason 8 or higher.

He then says with a Gleason 8 or higher, the lymph nodes are very important. He says that "some surgeons no longer do the lymph node dissection at all, because finding positive lymph nodes is - fortunately - so rare these days." He adds "we continue to do lymph node dissections in all patients."

No statement made as to how many nodes are involved in a normal surgery.

Interesting 142 (thanks for info) so we know a top guy like Dr. Walsh will sample for certainty(which is what I thought), how many might be based upon his overall assessment. So why are some patients not sampled at all, so are some patients getting a lesser protocol and treatment? (I think it is fair game for questioning). Thanks too, Brainsurgeon (the micro mets seems right on with what Dr. Barken has referred too), it seems like a wise statement maybe that percentage is correct, atleast he mentions such. Logically(my guessing of course.. the closest lymphnodes to the prostate(or first traveling spot) should be first in line as suspect if PCa escapes from lymph-system (not including perinural invasions-which is another means of escape), if that assumption is correct, then why are they not sampled on all patients and quick pathology done during surgery to assess if there PCa beyond the gland and if so...inform the patient as to it being a non-curative scenario..but still could be chosen and many do elect to have it removed to 'debulk' overall tumor burden on the patient even though non-curative, (which this protocol is done on some patients).

Just knowing this from these two examples, do you think patients should have alot more questions about the whole program???? Maybe another reason to get second opinions from leading surgeons for patients considering this modality and ask such questions to hear how they are answered or assessed, etc. Might make a big difference in ones outcomes, depending upon whom you had chosen, something to consider perhaps.