Lymnph nodes not biopsied

So, I was just thinking, my lymph nodes were not biopsied, and I wonder how common that is, and if that was a good idea. After the operation 18 months ago the surgeon told me that the prostate unattached easily from the nerves, and was not sticky, so he spared the nerves. The pathology showed 4+3 with no extracapsular extension, though it was less than 1 mm from the edge. My PSA has been undetectable, so far so good, and my surgeon had over 300 Da Vincis at the time, and a bunch of opens, but now I wonder if the lymph nodes should have been looked at.

My surgeon said that "it depends" - he took 12 in my DaVinci. We've seen more and less or none from a lot of those who have posted their pathology.

- it used to be the "norm" that the lymph nodes were checked first
- if there was a sign of cancer the procedure would be stopped.
- since radiation would be a better course of action with less side effects if the cancer had already escaped the prostate.
-but since joining HW, it appears it is that is not the case anymore - it is up to the doctor and the hospital to decide what to procedures to follow

-when in doubt , contact the surgeon and find out - remember, there is no such thing as a dumb question - only the question that is not asked.

hugs,
BRONSON

Before my husband's divinci surgery his doctor said he was going to biopsy his lymph nodes. After surgery he told me that he did not biopsy the lymph nodes. I guess when they get in there they can tell if they need to biopsy or not. His margins were clear.

For me they took 18 and biopsied 18. All negative.

I'm not sure about this, but taking nodes to biopsy can increase the risk of complications involved with surgery..Sometimes abdominal drains must be put in place to drain the disturbed lymphatic system..A condition called "Lymphocete", something like that, can result and a fluid filled pocket or abscess can form requiring further treatment..Sealing off the cut lymph ducts is tricky..I speak from first hand experience..But in high-risk patients, they usually do it as the information gained is deemed worth the risk..

It's interesting that some surgeons do not dissect at least some lymph nodes. I can understand in G6 cases where active surveillance was also an option. But in intermediate and above risk cases there is very clear evidence that removing lymph nodes can be very helpful. Dr. Stan Brosman summarized it is his essay on the AUA2010 meetings in San Francisco. Guys like me had a a 100% improvement in biochemical failure and in prostate cancer specific mortality when the study period was extended to 18.4 years...

I just wonder how many doctors stay up to date with that stuff...

Tony

Some of the clinical guidelines use a nomogram to assess the probability of spread to the lymph nodes and if the probability is less than 2% (or 1% for some physicians) they don't biopsy since there is some adverse side effects in some cases of removing lymph nodes. This is more rigorous than simply going by a hunch or by the feel of things intra-operatively.

You can go do the sloan kettering nomograms to check on the odds for your particular case after inputting your gleason, biopsy results, and other info.

Or you can google on CAPRA score; if your score is 1, 2 or 3 out of a possible 10 then your odds of lymph node spread is less than 2.5% and many docs would say no need to remove and dissect LN's.

That said, some docs think LN's should always be examined, regardless of the odds. Walsh seems to be in this group.

If you were EPE-, SM- SV- with nondedetectable PSA for 18 months, I'd say the doc made the right decision and the possibility of LN+ would have been extremely low under these conditions. But that's just my guess; check the nomograms and see.