Lymph node inolvement?

I talked to someone from the Cancer Treatment Centers of America and while her initial advise was good ( it was what I wanted to hear) she became confused over HDR and IMRT so I don't know how much was experience at the center and how much was quickly looking at the prostate treatment pamphlet. I am wondering if there is a way without going through surgery, for the urologist to know if there is any lymph involvement?  In the report from the pathologist after the biopsy, it said I had a stage T1c. Would he know from the ultra sound whether or not the cancer was encapsulated?

 

I believe a prostascint scan fused with a CT or MRI scan may pick up lymph node involvement. But it is not foolproof and can give both false positive and false negative results. The surest way is as has been suggested, a needle biopsy of the lymph nodes should reveal if tumour is present there. With regard to staging.....usually the pathologist will give a staging based on the biopsy samples ......... i.e. if the tumour is not at the ends of the specimen plugs and this is true for all plugs, then the pathologist will make an assessment that the tumour is confined to the prostate. The more samples the more accurate the basis for his judgement of stage. But, areas not hit by the needle may contain areas that have escaped the gland itself and this is why staging often is changed following surgery. I don't think that ultrasound is really accurate in mapping extent of the tumour within the gland.
Bill

Hopeful,
You are treading the same road that all of us have walked. With all of the reading, talking, etc., I found there is no absolute way of knowing what your cancer involvement is short of taking it out and looking at it. Even then there can be no guarantees it has not traveled through the blood to some other place and will show up later. This is more prominent with a gleason 7 or above & high PSA, even though the statistical odds are in your favor if it is confined.

The differences between radiation and RRP (removal) came down to this with me. The advantage of radiation was the strong possiblity that if it was not confined to the prostate, the radiation would get it by radiating the entire area. My radiation doctor wanted me to also take Lupron (harmones) in conjunction with the treatment as my biopsy was right on the edge. On the other hand, if the radiation did not get it (it came back later), I would have less options or more difficult options on the salvage side. The side effects of radiation appear to be less (not in all cases but most), but in time the side effects of RRP may actually be less (assuming it is successful in being rid of the cancer) in the long run. I ended up choosing RRP because I wanted to know my cancers condition, and I wanted to reserve more options should it not be confined or should it return. As one person put it to me "I wanted the cancer out of my body."

Now, in saying all the above there are no wrong decisions - there are options according to what is most important to the person. It is very likely that you will be fine which ever direction you choose. God help you to choose and have peace and healing going forward. RB

RBAge 61
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA .04