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Importance of lymph node dissection even in patients with with very low risk of spread to nodes

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Posted 4/8/2011 11:26 PM (GMT 0)
Dr. Menon removed 2 or 3 nodes. They were negative.

Mel

Posted 4/8/2011 11:35 PM (GMT 0)
Tony,
It would be interesting to understand if the lympnodes were already infected with micromets that weren't detected by the pathology or ended up infected by circulating cancer cells later.
I remember reading a few years ago that it is extremely difficult for a patholigist to detect an infected node with a small amount of PC.
I think the main idea of the scan is to make the determination up front as a positive scan swings the choice between surgery and radiation much more to the radiation side.
It was strongly recommended that I get both lower and upper body radiation with a psa of 40, and that recommendation would only be nulified by a clear scan. Fortunately it came up clear and I avoided the radiation; to me the scan was well worth the time effort and cost.
JT
Posted 4/9/2011 4:13 AM (GMT 0)
Mel,
I have seen quite a few of Mani Menon's patients stop in here and in my observations he is of the breed of doctor that when he opens someone up and find's a positive node he stops there and closes them back up. I think we will see that continue to change as time moves on. There are issues with taking a lot of nodes but the efficacy on cancer is very good when they are removed. I think that it may come down to a patients decision if things keep getting reported as they are in the studies over the last few years. I think that because of the risks in doing so that it should be the patients decision but we are not at a point that a surgeon will ask a patient nor that a patient will ask the surgeon. For my part I'm glad ten were removed and many others irradiated.

@John,
What we need to find out in study are whether using node scanning is beneficial considering the latest findings. If there are more than 40 iliac nodes alone then even with the numbers produced that you cited means there is potential to miss detection in every case. Also the only reason we know how effective this scan is is because they were biopsied after the scan to verify accuracy. This means that biopsy is still more accurate. No doctor can see a single culprit cell left behind even with this scan. The studies show that regardless of whether there is detectable cancer in the nodes the more removed or treated the better.

We really need to have comparative data of the morbidity versus the survival benefit. That would be a long wait for results...

Tony
Posted 4/9/2011 4:16 AM (GMT 0)
Newporter,
Thank proscapt for reviving a very good topic. Good stuff...

Tony
Posted 4/9/2011 12:15 PM (GMT 0)
"I have seen quite a few of Mani Menon's patients stop in here and in my observations he is of the breed of doctor that when he opens someone up and find's a positive node he stops there and closes them back up. "

TC, I hadn't thought of that as perhaps being a reason why certain surgeons have such better results reported on things like positive margins. I'm sure Menon is one of the best out there, but if he excludes patients with positive nodes, that will certainly result in better positive margin rates. Not saying this is a bad practice, in fact, it's probably a good way to do it, but it helps me understand another factor that goes into results provided by different doctors.
Posted 4/10/2011 1:22 AM (GMT 0)
I am surprised Dr. Menon stops the prostatectomy when he finds a positive lymph node. I wonder what his rational is since the patient is already on the operating table.

Looks like every surgeon is different. Mine told me he took the prostate out, then examined the lymph nodes, told himself that to be on the safe side, he ought to take a few out to examined. Took 4, they were negative then he stopped and closed me out.

I know that for breast cancer, after removing the tumor, the surgeon takes out a number of sentinel lymph nodes to examine, if positive, he just keeps going until he sees some negative nodes. If the nodes are positive, the patient goes for chemo and radiation after surgery as additional treatments, i.e., they throw everything including the kitchen sinks at the cancer. (Actual cases for my close relatives) Always wonder why PC treatment is different.
Posted 4/10/2011 2:00 AM (GMT 0)
Newporter,
Years ago it was standard protocol to stop as soon as a positive node was found, because it was thought that surgery would no longer result in cure and other treatments like HT or radiation would be more appropriate. It seems like some doctors still hold this view. Others feel that removing the prostate even though mets are identified provides a value in that the major source of the tumor burden is removed and results in other treatments being more effective.
Again, just another example of opposing views among experts.
JT
Posted 4/11/2011 12:37 AM (GMT 0)

I had a total of 14 lymph nodes removed for pathological examination.  4 were Peri-prostatic, which is to say, in the immediate area of the prostate.  Then pelvic dissection was performed bilaterally down to the pelvic “sidewall” to obtain a representative sampling, (10) in my case.  Prior to surgery this was my understanding of the operative plan. All nodes in my case were cancer free.  I might add that the deep pelvic dissection adds significant amount of time to the overall surgical procedure.  This could be a limiting factor in some cases. 

Hero

Posted 4/11/2011 5:32 AM (GMT 0)
Thank you John T for the reply.
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