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Opinions on removing Lymphnodes?

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Posted 8/23/2007 7:59 PM (GMT 0)
As I interview perspective Da Vinci surgeons I find that some do and some don't take the lymphnodes. if you don't have signs of more aggressive cancer.(very high PSA and Gleason) some I have talked to don't, where some always remove them as standard procedure. What's the concensus?


I have been recently diagnosed with prostate cancer .
I am 55 yrs. old. My PSA is 3.9 w/ .5 Free PSA and 13% Free PSA. My
biospsy results indicated 3 of 12 samples were cancerous with a
gleason score of 6.
Posted 8/23/2007 8:10 PM (GMT 0)
My davinci surgeon told me before my surgery that due to my high gleason score on biopsy (8) that he would probably take an extra wide margin and also a couple of lymph nodes. I don't know if this is usually done on pt's with lower gleason scores....probably if they are sure it is confined to the capsule they would do it. I also had a positive dre which probably added into the mix somewhere...
Posted 8/23/2007 9:27 PM (GMT 0)
I have seen this here, too.

I cannot see the benefits of NOT taking them. As this is one of the first areas to show if metastatic disease will be an issue, I would make sure that my surgeon clearly state his intentions BEFORE surgery. i did not know to ask when I had my surgery. But My surgeon removed and biopsied 10 lymph nodes. And I am very glad he did. Interestingly, my radiation oncologist has the same philosophy and studies to prove it. When I went in for adjuvant IMRT treatments, he told me about studies that are showing that when having radiation for prostate cancer that Whole Pelvic Radiation Therapy (WPRT) is proving to lower recurrance rates. By WPRT he refers to shooting the local lymph nodes as well as the prostate and/or prostate bed. So I have it two ways. Ten were removed at surgery (clean) and the rest were shot with IMRT. This sounds right and I would question those doctors that do not remove them. Again, I believe that this should be dicussed with every LRP/RRP or radiation patient. jwb187,  You should ask your radiation oncologist about the S.t.a.n.f.o.r.d. study for WRPT.

Tony

Tony

Posted 8/23/2007 11:33 PM (GMT 0)
Just a thought on lymph nodes,

Considering a man who has a clinical presentation = to, a low Gleason, low PSA, less than 50% in any positive core and less than 30% of the cores positive, there is a 1% chance of cancer having spread beyond the prostate. Statistical as it is, it is generally a good guideline for surgeons. Besides, they get a gander at them little clusters of grapes when they get inside so anything appearing suspicious is tested anyway. Even a little enlargened, a node gets quick attention.

Now, for 1% risk I'd avoid losing lymph nodes when ever possible. Lymph drainage becomes more of an issue when we age. I'd personally like to avoid poor lymph drainage if I can.

Swim
Posted 8/24/2007 1:14 AM (GMT 0)
Thanks Tony for the information about the Whole pelvic radiation therapy, I have my marking and pre radiation consult coming up in a couple of weeks and that will be one of the things that I will be asking him about. I was wondering how much and exactly where they would concentrate the radiation since the prostate and all the trimmings were gone...jwb
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