How many lymph nodes were taken at your RP?

3/11/20 Edit:

Here are the results for the numbers we entered up to my blue line on page 3. I had to make assumptions in a couple of cases. I think the median may be a better indicator -- the mean may be skewed by a few guys who had a rather large number removed. And, of course, we have little data, so this is very informal and more a curiosity. For real-world data, it would be more useful to know the percentage of G6 and of G7 (3+4) who had no nodes taken, and the medians for those with nodes removed. It makes little sense to include all the zeros in the calculation -- more useful is the the typical number taken when any are.

Forum node numbers grouped by biopsy G score:

G10: 1 value; Mean & Median = 16
G9: 6 values; Mean = 26.5; Median 20.5
G8: 8 values, Mean = 8; Median = 8
G7 (4+3): 11 values; Mean = 9; Median = 8
G7 (3+4): 20 values; Mean = 8.6; Median = 9
G6: 2 values; Mean = 4.5 Median = 4.5

Here is a study with some stats:

The number of negative pelvic lymph nodes removed does not affect the risk of biochemical failure after radical prostatectomy (2010, Full Text)

(In this study, the median LN yield was 7 and the range was 1–42)
____________________________________________________________________
I saw in a brother's signature that his surgeon removed one lymph node at his RP based on the G7 (4+3) biopsy. I questioned this, not sure if it was a typo, but he confirmed it was correct.

I asked because removing only one lymph node for a G7 (4+3) biopsy is, IMO, rather unusual. For those of you who had RP, I'm curious to learn the number of nodes removed and your pre-surgery (biopsy) Gleason score.

If there are enough replies, I'll tally the results when the thread settles and put the results in this post

To frame things, my surgeon removed 16 nodes at my RP based on my G10 biopsy. From what I've seen for G6 (3+3) -- and some G7 (3+4), surgeons are about evenly divided between removing no nodes and removing two or three (it's rare to have a positive node with G6 -- it means a higher-grade, metastatic lesion was missed.) Removing too many LNs can lead to lymphedema. On the other hand, since about one-third of G6 men are upgraded after RP, I wonder how prudent it is to remove no nodes at all.

When nodes are removed, the most important to take for examination is the "sentinel" node. This is the LN closest to the prostate on the chain of nodes leading away from the prostate. The theory is that if there is metastasis via the lymphatic system, the node closest to the prostate would by a likely place to find a met. So if you had just one node removed, it's likely to have been this one.

The sentinel node concept in prostate cancer: Present reality and future prospects (2008)

For higher-risk PCa, surgeons usually remove all the nodes in a selected "template," which is the area delineated by a known set of anatomical landmarks: blood vessels, muscles, etc. Generally the higher the biopsy grade, the bigger the template, up to what's called an extended pelvic lymph node dissection (ePLND), as in my case. I'll ask my uro/surgeon how many different size templates there are. He lets me have "question time" at my visits ;)

I'm curious to see how the number of lymph nodes removed correlates with G score, and how wide the number range is for a given G score (I believe the latter may just depend on anatomical variation person to person -- the surgeon just takes what he finds in the chosen "template" area.)

Djin

Post Edited (DjinTonic) : 3/11/2020 12:39:59 PM (GMT-6)

On GS8, 7 were removed.

3+4, only EPE was microscopic bladder neck invasion, but surgeon took 12 nodes.

Cleveland Clinic, not sure if it was just his protocol/routine, or if he did it due to PSA of 12-15 and 43 year old patient.

G8, 3 lymph nodes, all neg.

Here's an article on the question, from 2018. It mentions awaiting the results of two ongoing studies -- I wonder if they've now concluded. The article is far too technical for me to grasp the details, but bottom line: the authors conclude that there's a correlation between extended pelvic lymph node dissection (PLND) and longer time to biochemical recurrence, but no correlation to overall survival rates.

Effect of the number of removed lymph nodes on prostate cancer recurrence and survival: evidence from an observational study

I'd like to know whether there's a downside to extensive PLND in terms of overall health. Even with only 3 LNs removed, I developed a painful lymphocele that took months to resolve. If extensive PLND increases lymphocele risk without improving PCa outcomes, maybe that's a consideration for some surgeons.

4 taken based on 4+3 biopsy, don’t recall our conversation very well.

DT....I should probably make a clarification on my post RALP pathology report:
The report does indicate:
Number of lymph nodes involved: 0
Number of lymph nodes examined: 1
But earlier in the report it also states:
B. Left pelvic lymph node, biopsy:
One lymph node negative for neoplasia (0/1).
C. Right pelvic lymph node, biopsy:
Fragments of fibrofatty tissue.
No tumor seen.
No lymph node tissue identified in sections examined.

I had 7 removed. Three on the right and four on the left. All were negative. I'm pretty sure as a result I have lymphedema in my right leg.

Thanks for the paper link, S.P!

Funny to see the overall avg. number removed was 16.6 and I had 16 removed. Like many studies in the world of PCa, here, too, they found a positive correlation between number LN removed and time to BCR, but, unfortunately, this doesn't improve overall survival. It would have been nice to have data on adverse effects vs. number removed, but this is probably hard to come by.

Purely anecdotal, but I had no adverse events or effects from my LN removal.

Djin

AJMan said...
Had 10 removed for a 3+4 biopsy but I think he mentioned MRI as also being informative as to the plan given location of tumors.

That brings up the subject of imaging. Enlarged nodes are suspicious for being positive. I don't know how that affects the removal plan.

Djin

Indeed. In my case the suspicion I think came more from tumors abutting the capsule in MRI thus perhaps increasing the chance of EPE (which indeed was confirmed) and perhaps nodes by the same token?

GS 7 (4+3), after RP downgraded to 3+4.
Number of LN removed: 8
All negative.

22 tolal 16 from one side

G8, 9 nodes