What's the Big Deal with Radiating Lymph Nodes

There are side effects of radiating a wider field. Colitis being the more common one. I had pelvic radiation done and it was not too bad.

So, do we not need those lymph nodes, or are there consequences to not having them?

Snuffy Myers believes all SRT should include pelvic area. He says that it is the first place PC will spread.

My first visits with RO found him relyctant to do it. If/ when I do SRT, I will insist on the wide field SRT.

Kark,
It was REALLY controversial when I agreed to the protocol. Today, I think it's only controversial when you meet an RO that isn't current. In the last two years we have seen many studies disprove the theory that if it's in the nodes it won't help treating with local therapies. To the contrary we have are learning that surgeons should remove as many as safely possible in men who showed intermediate and high risk characteristics during the biopsy. Same goes with the radiation protocols. The next debate on the horizon is whether it's better to do it surgically or with radiation. Some theories I've read say surgical removal will have the lesser lymph node related issues because the surgeon can resection critical pathways. Additionally irradiating a wider area can have other repercussions. Others say it is still safe to do so with radiation.

@ Fairwind,
I do remember that my first 28 sessions were WPRT. The final ten were directed at the prostate bed.

Tony

Goodlife, I'm not questioning your decision to have the lymph nodes radiated. My point is, if the RO is hesitant to do so, maybe it's because he's not experienced or has had bad results laying out the area to be radiated, and is afraid of SEs. So I thought it might be better to find an RO who has confidence he can define the field to be radiated including lymph nodes.

I understand your insurance issues but you could at least ask your RO specifically as to why he would not prefer to do it. If it's an insurance issue or he doesn't think it's necessary that's one thing, and you could press the issue. But if he admits he's not good at that specific procedure I would run and find another guy regardless of insurance.

My RO said he would only radiate the prostate bed. I relied on his expertise.

He also said 68.4 total Gy. in 38 sessions.

When I suggested maybe one more session, he said no because even one additional session can have a huge difference regarding SE.

I think some of you are playing doctor, telling the RO what to do!

Mel

Mel,
Each case is different. Every doctor will, or at least should, start from that plane. But using a line from my captain ~ 50% of all doctors are below the acceptance of knowledge that they should be at. I for one would always stand by your decision to rely on what you were told. I think it's incumbent on the medical community to make sure THEY are sure of what they tell patients. There are reasons to still be in the 2006 mode that told me when I did it that what I did was aggressive. I think 2011 has made a difference in this area and now most I talk to now say it was appropriate (little credit to me because I was relying the expertise). You should re-ask these questions to your RO with each weekly visit you should be having.

Our friend Mr. zufus is right ~ question everything...even if it means over and over...

Tony

MeL,

I do appreciate what you are saying, but to date, I am not convinced that all the fine doctors I have consulted and had involved in my case truly have all the right answers, and have given me the best advice for me. I am one patient out of a thousand to them. The one minute they spend scanning my chart while they stand outside the exam room door doesn't compare to the time I have spent going over my records, reading on the Internet, and investigating treatment options.

I know, I know, they have years of education and read journals. Most of them don't know about Snuffy Myers, Fred Lee, Dr. Scholz, etc. Doesn't mean they are really up to snuff on Gleason 9 patients. They usually give me some statement that translates to we don't really know.

This is my body, my PC, and my life. I had a good shot with the surgeon who bought me at least 2 years cancer free. If I had done what my first doctor said, I would not have been so lucky. Now I am looking at radiation most likely. One shot. So do I say "ok mr. Doctor, whatever you decide is what I will do.". Or, do I spend hours doing research and say to the doctor, I believe that wide field radiation makes the most sense for a Gleason 9."

I don't look at it as playing doctor, but rather being the person with the most vested interest in getting the best and most thorough treatment available. If I am wrong, then, I may die a few months early, but at least I know I did everything possible. If the doctor is wrong, well, I was a Gleason 9 anyway.

Sorry about the rant, but I really think we put way too much trust in the medical profession. They just can't take care of every patient they have the way they should.

Goodlife

goodlife, 66-68 should be good and safe for your goals, sounds like a good plan

TC you really seem up on this lymph node thing , so I started googling to ck it out. I found one study that said for every lymph node dissected, your chance of BCR is decreased by 3% have you seen that one. I had a 4 1/2 hour prostectemy, few seconds for me, and wondered why, never asked doctor. When pathology came back I knew why, 27 lymph nodes dissected all clean, probably done by his staff, there were five in the operating room with him plus 2 anethesiologist. Hey Im not complaining the doc didn,t do it all, its a teaching hospital, knew that up front. When your flying 50% of the controllers are trainees doing live OJT, with someone like me responsible ready to step in. I know mets could have been released before surgery but.......
I was concerned about effect of lymphnodes loss in a negative way,re immune system ,dont know, will stick head in the sand on that one. I like the firewall tho, which is what my local urologist called it. Suffered all the SE's pratt drain in for a month, lymphoceles around for 3 mos before resolving itself. But worth it. Having said that, psa anxiety building, due in June, postponed till July, Chapel hill, than Big Apple for the month of June.

At least we have a current phase III clinical trial that may provide some answers.  Currently, the RTOG is conducting a phase III, 3-arm, study (RTOG 0534) to examine the potential benefit of adding 4~6 months of androgen ablation therapy to salvage RT and to address a potential role of treating pelvic lymph nodes. 

Carlos