Lymph node excision with Prostatectomy

FYI, my surgeon took out two lymph nodes, both of which were negative for cancer. I've seen people here report a dozen or more nodes removed.

Detroit here, got 2 removed for examination during surgery. "There is exposure, but no malignancy...yet." Thus the IMRT.

I had 29 nodes removed all negative...went in with with "good" clinical pathology...it was at a U Dub...4.5 hour op...teaching hospital...they all did a thorough job...post op path was excellent if you don't count a significant upgrade from a gl7 hard to a gl9 due to 2 foci of gl5...developed 2 lymphoceles[google] which self resolved post op.{ i do count the upgrade but am not concerned ...we all "die" from something} at this point in time the only way to determine positivity of cancer is under a microscope... period...and you are correct...it is water gone by...there is no valid crystal ball for this disease...do what ever you think is best and good luck...my opinion is you are doing quite well...as are the vast majority of folks with Pca...here and elsewhere...little comfort for those who are not...but there it is...

You're wondering if you'd done things differently would your psa have moved.

There's a guy on here who had 44 lymph nodes removed. One was malignant. I had two removed, neither was malignant. What does that tell us in the big picture of things? And I still have the swollen left ankle for my efforts. (It doesn't bother me...but you get my drift...I hope)....placing a feeling of security...on what??. Another decision?

We're doing the best we know how to do with a (for lack of a better term... rather bizarre) disease whose treatments are all over the map. So much out of our control...

No two people's journey with this disease is the same. No two people's life's journeys are the same.

You're life is continuing. And by all appearances....will continue to do so. Do with it what you will.

(man our paths are similar..identical??. only my margin was 3-5 mm (depending on who you ask). I also waited 4 years for a biopsy. lol smart?? No. Fortunate? From what angle?

Allen said...
PLND has a lousy record for detecting cancer in the lymph nodes.

This article claims that 33 of 34 patients are correctly staged and most of the LN+ are removed. Maybe the technique isn't too bad if performed by a competent surgeon? Far from all surgeons are competent.

Mapping of Pelvic Lymph Node Metastases in Prostate Cancer

An extended LND (eLND) would have correctly staged 32 of 34 patients but would have adequately removed all LN+ in only 26 of 34 patients. When adding the presacral region, these numbers increased to 33 of 34 and 30 of 34 patients, respectively.

Gemlin- Perhaps their experimental "intraprostatic technetium-99m nanocolloid injection" technique will be validated in a larger series. That is not used widely in the US or Europe.

George- Its value remains to be proved, but that is a different discussion.

There are usually two reasons for LND: assessment of cancer spread and debulking the tumor. I was refering to debulking the tumor.

I prefer a PSMA PET/CT to determine the cancer spread since it has less side effects than an LND and can also determine distant metastases.

George

This may be another area of contention. I have 14 lymph nodes removed, one which was "100% cancer". As a side note, I had to argue with the surgeon before the operation to continue with the surgery even if they found a positive lymph node. (Many surgeons believe that if it has spread then the benefits of removing the prostate are overweight by the negatives of the operation.)

One thing that the surgeon stated is that he always takes out a "representative sample" of lymph nodes and does a cryo pathology in the operation room before he decides to take out the prostate. He felt that gave him a better result than CT scans.

(or when the nomogram risk is >2%).

Tall Allen, can you please explain what this mean?

Thank you.

raypaul-

It is explained in the link, which also has a link to a nomogram. Some think that 2.6% is a more appropriate cutoff for PLND. The calculated risk for LN mets for radiation is often set at 15% -- above that, they include the pelvic LNs; below that, they don't. It's all based on past data on whether men with that set of risk factors were eventually discovered to have had cancerous pelvic LNs. Eventually, we'll have better data from randomized clinical trials now running.

Jack & Diane said...
When my husband had his MRI it happened so fast I didn't even realize at the time that they were also looking at his lymph nodes. We got the MRI results back and it said lymph nodes are clear and even though I didn't initially realize they were looking at them via the MRI I felt relieved because they said they were clear. Then I quickly learned that just because they said clear on the MRI that did not mean there was no cancer in them because it could be so small it is not causing them to be enlarged. Even now after they have dissected them I still don't feel 100% comfortable based on what I'm reading in this thread.

agreeing with Bololidat's post. The nomograms for Jack show him as....for all intents and purposes....for the most part....cured. The only 100% you get as far as prostate cancer is concerned is being born a woman! Jack's case is just about the next best thing.

Sometimes these threads veer off into the weeds....causing us to lose sight of the much larger (and more realistic) picture.

island time said...
..There's a guy on here who had 44 lymph nodes removed. One was malignant. I had two removed, neither was malignant. What does that tell us in the big picture of things? And I still have the swollen left ankle for my efforts. (It doesn't bother me...but you get my drift...I hope)....placing a feeling of security...on what??. Another decision? ..

I'm the guy that had 44 nodes removed . I was originally a 3+4 then upgraded to a 4+3 after pathology. With one positive node, that moved me into another risk category which indicated follow-up treatments. I also had the Decipher genome test performed on the excised prostate tissue which also placed me into a high risk category.

So two good validations that I needed to go through ADT and then SRT.

I do have bilateral lymphodema but I am controlling that with support stockings and I have a pneumatic compression leg wrap that squeezes my legs from the feet up, alternating legs every day. I actually don't mind the daily 'squeezing', it's like getting an hour long leg massage, feels good. I don't need to do this every day, even a couple of days a week would probably work but who can resist a free massage?