Lymp Nodes not removed during robotic surgery

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positivelife
Regular Member


Date Joined Feb 2008
Total Posts : 42
   Posted 4/20/2008 6:00 AM (GMT -6)   
Let me first thank you all at Healing Well. What a bunch of great guys you are all !!!. I log on at every opportunity I get, to improve my knowledge of this dreaded disease which we should all conquer.

I now realise that my lymph nodes were not removed during the robotic surgery,although Dr Walsh's book (chapter 8) says it is better to remove them for ALL patients during surgery what ever be the risk profile of the patient. I understand that the chances of lymph node involvement are small for my type of disease; nevertheless if I had the knowledge then I would have asked it to be removed during surgery. Has any of you had the lymph nodes not removed during robotic surgery ? Is it possible to have the lymph nodes removed after the surgery;is it a good idea, what are the other options if not surgery? Any opinion would be much appreciated.

My first 3 month psa test is coming up, apprehensive.
Dx Age 48 Nov 07

PRE OP
Psa 4.5, Biopsy 2/8 cores positive Gleason 3+3
Wished had done enough research but was in muddy state of mind
Robotic surgery Jan 08

Found Healing Well Forum Feb 08

POST OP
Geason 3+3 ,10% both lobes, There is perineurial invasion
No extraprostatic spread seen , Seminal vesicles normal,Nerves spared
Cancer close to apex but margins clear T2c NXMX
Incontinence bad but in April 08- suddenly down to 1 pad
ED - started cialis once every 2 or 3 days from April but no improvement


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 4/20/2008 7:15 AM (GMT -6)   
I had a lymph node disection and the way it was explained to me was because of the aggression of the cancer. I am a gleason 9, my understanding and trust me I am no expert is if the doctor determines that it is unlikely of any spread the usually opt not to do the lymph nodes. I think your doctor took the right approach. After my disection I developed a post op hematoma due to a leaking from the lymph area not healing well and I had to have that drained. So I am sure there are some inherent dangers involved. Keep the hope and dreams alive and well and please keep us posted as to how your healing progresses.

peace and grace
Dale
My PSA at diagnosis was 16.3
age 46 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
 


Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 4/20/2008 1:49 PM (GMT -6)   
Remember, Walsh's book is now considered old - there have been newer editions, but info like this might not be the latest thinking. There have been several studies that now say that their removal is not that important for the low risk guys. Talk to your doc or get a second opinion. The stress you're experiencing from this is not good for you either. You deserve to get to a place of peace of mind.
Paul
47 at Diagnosis.
Father died of Pca 4/07 at 86.
1/06 PSA 3.15
1/07 PSA 4.6      (Biopsy 3/07 just suspicious)
10/07 PSA 5.06   (Biopsy 11/07  1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC  www.roboticoncology.com
Saved both nerve bundles.
Path Report:  Stage T2cNxMx
-Gleason (3+3)6
-totally contained to prostate,
-10% involvement in L & R Mid lobes
PSA 0 at six weeks
Pad free on March 14 - (10 weeks.)
ED - Take 100mg viagra every night.
Totally usable erections at 10 weeks.
 
 


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 4/20/2008 11:24 PM (GMT -6)   
I had the DaVinci procedure last August. One lymph node was removed during surgery. The prostate together with the lymph node was checked immediately before surgery was finalized and it was determined surgical margins and the lymph node were clear. I can only assume this was why no further nodes were removed in my case.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07----4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable


positivelife
Regular Member


Date Joined Feb 2008
Total Posts : 42
   Posted 4/21/2008 5:04 AM (GMT -6)   
Thank you Dale,Paul & Bill. Your comments are much appreciated. Sometimes things get you down for no reason; and responses from others help a lot. I will ask the surgeon at the next meeting about more info on my nodes. john
Dx Age 48 Nov 07

PRE OP
Psa 4.5, Biopsy 2/8 cores positive Gleason 3+3
Wished had done enough research but was in muddy state of mind
Robotic surgery Jan 08

Found Healing Well Forum Feb 08

POST OP
Geason 3+3 ,10% both lobes, There is perineurial invasion
No extraprostatic spread seen , Seminal vesicles normal,Nerves spared
Cancer close to apex but margins clear T2c NXMX
Incontinence bad but in April 08- suddenly down to 1 pad
ED - started cialis once every 2 or 3 days from April but no improvement


StuckInTraffic
New Member


Date Joined Mar 2008
Total Posts : 14
   Posted 4/21/2008 12:02 PM (GMT -6)   
Similar to your case (from age 48, PSA 3.1, Gleason 3+3=6, T2c to surgery time and improvement of continence!), my lymp nodes were not removed during the surgery (Laparoscopic). My surgeon said it was not necessary since the cancer was in early stage, not yet agressive and contained. So far so good, 1st post op PSA is undetectable. Good luck on your upcoming PSA test.
Age: 48 (June 2008)
DRE normal, PSA 3.1
08/28/07: Diagnosed cancer, T1c, Gleason 3+3=6
02/27/08: Laparoscopic Rad. prostectomy @ Anaheim Kaiser, 4 hrs.
              Both nerve bundles spared
              Pathology Report: Tumor confined w/in prostate
              T2c, Gleason is 3+3=6
              Surgical margin: Focally involved by tumor in right apex
03/10/08: Catheter removed. Drip, drip, drip, drip...
04/07/08: 1st PSA <.01 :)
              Dripping starts to slow down :)
              ED: Started Levitra, no response yet. 


jrponalameda
Regular Member


Date Joined Dec 2007
Total Posts : 56
   Posted 4/21/2008 2:12 PM (GMT -6)   
I also had DaVinci without lymph node removal... so far so good, my 3 month PSA was undetectable. Sounds like they leave them fairly often when it's caught early. Have confidence in their assessment! Hang in there and good luck!
Diagnosed Sep 2007 Age 54 Gleason 6 (3+3)
DaVinci Surgery 11/8/07 University of Minnesota
2/22/08 PSA Undetectable


CT
Regular Member


Date Joined Apr 2008
Total Posts : 25
   Posted 4/21/2008 2:55 PM (GMT -6)   

This is my first post.  My story is very, very similar to positivelife's....see my info below.

My doctor also did not take out any lymph nodes.  I was concerned as well, but from what I understand, that is not necessary for our situation.

Good luck to all on our jorney.


Age: 50 (March 2008)

DX 1/08 @ 49 yo

7/05: PSA 2.6 DRE Normal

9/07: PSA 3.4 DRE Normal

1/08: Biopsy 1 of 12 cores with 10% involvement, T1c, Gleason 3+3=6

4/08/08:  Laparoscopic Rad. prostectomy @ Banner Thunderbird, 5 hrs.

                Advised both nerve bundles spared

                Post Op Pathology Report: Tumor confined w/in prostate, pT2c, NX, DX 

    Gleason is 3+3=6, bilateral with 15% total involvement near apex

                Margins and Seminal Vesicles negative!!!

4/18/08:  Staples and Catheter removed. Drip, drip, drip, drip...


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 4/21/2008 3:07 PM (GMT -6)   
Someone correct me if I am wrong, but I believe that one of the ONLY negatives with the Da Vinci is that often times surgeons are not able to get the lymph nodes for biopsy during surgery. When my father had met with the his original urologist, he wanted to do an open prostatectomy because he wanted to biopsy the lymph nodes and didn't feel he would be able to if he did the Da Vinci. (He did not have very many Da Vinci's under this belt) However, we decided to go with a more experienced surgeon and he in fact was able to get a few lymph nodes. I was under the impression that it depended on the surgeon, anatomy etc. as to whether or not they could biopsy the nodes.
Hopefully, your PSA's will come back undetectable and you will not have to worry about it :) Try to stay positive in the meantime. Best wishes!
Father's Information
DX July 15, 2007
Age 62 (now 63)
PSA 5.5
Original Gleason 3+4=7 
Post Surgery Gleason- 4+3=7
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin
One positive node
Bone Scan/CT Negative (Sept. 10, 2007)
T3a N1 M0
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07
Lupron beg. Dec 03, 2007 2 yr
Radiation started March 03, 2008 8 weeks 5x a week
5 weeks of radiation down!!!
 
 


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 4/21/2008 3:30 PM (GMT -6)   
I had RRP and along with the prostate, had two lymph nodes removed (left and right) -- is that all there are, or are there more? They turned out to be free of cancer. I was Gleason 4+9=9 pre-op and downgraded to 4+4=8 post=op, with the cancer confined to  the prostate.
 
Positivelife, as you would need another operation to remove your lymph nodes now, I don't think that is something you should seriously consider -- unless of course your doc thinks otherwise :-)

Age 63. Other than cancer, in good health
Left hemi-colectomy April 2006 (colon cancer)
PSA 5.7, Gleason 4+5=9
RRP 7 March 2008, non nerve sparing
Histology showed clear margins and lymph nodes
Two nights in hospital
Catheter and staples out after 7 days
Continent, no pads needed from the get-go
No erections (of course!)
Experimenting with VED and Bimix
 


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2302
   Posted 4/22/2008 9:20 AM (GMT -6)   
My urologist did not do a bone scan prior to open surgery, as some do, but did remove a couple of lymph nodes during the procedure on the outside chance that any cancer had spread outside the prostate.  I'm glad he did for my own peace of mind. 
Age 59  PSA quadrupled in 1 yr (0.6 to 2.5) 
DRE neg  1 of 12 biopsies pos (5%) 
Open surgery June 2006 
Cancer confined to one small area of prostate
Gleason 5 (3+2)  PSA's < 0.1  


Lungman
Regular Member


Date Joined Jan 2008
Total Posts : 276
   Posted 4/22/2008 4:56 PM (GMT -6)   
My surgeon also removed one right and one left lymph node to rule out spread to local nodes, I am glad he did, for my peace of mind, even though I had little total involvement. Maybe ad DD stated, it was impractical to get to them, there is a lot going on in the lower pelvic cavity, and maybe the risk of damage to nerves and surrounding structures just was not worth it, trust his expertise and have confidence that he acted in your best interest.
46 you when diagnosed, now 47
Pre-Op PSA 9.9
1 of 12 cores positive, Gleason 3+3
DaVinci on 9/5/2007
Post-Op Gleason 3+6, Negative Nodes and Margins
Less than 1% of prostate involved with CA
3 Month PSA 0.01, 6 Month PSA 0.01
Incontinence resolved 9/15/2007, one day after cath removal
ED showing significant improvement, more notable over last month
with Viagra 100 mg.
Success with BiMix


positivelife
Regular Member


Date Joined Feb 2008
Total Posts : 42
   Posted 5/1/2008 4:33 PM (GMT -6)   
Received the first post op Psa results <.1 What a relief !!! Thanks for your replies TimG,Piano,Dotingdaughter,jrponalameda,ct, lungman and stuckintraffic.

For all those intending surgery - please remember to ask the surgeon about removal of lymph nodes. In my opinion, surgery is one chance to get the beast out;why not take the lymph nodes out as well? The risk of later spread to lymph nodes is only 1% for the lower gleason grade, organ confined, margins clear surgery; nevertheless it is still a risk !!

I get the impression that most of the robotic procedures does not touch/remove the lymph nodes whilst the open surgery does. Is this a distinct disadvantage of the robotic surgery process;difficult to manoeuvre the robotic arms around in the pelvic area ? Comments by those who had the surgery (whether open or robotic) would be most welcome.
Dx Age 48 Nov 07

PRE OP
Psa 4.5, Biopsy 2/8 cores positive Gleason 3+3
Wished had done enough research but was in muddy state of mind
Robotic surgery Jan 08

Found Healing Well Forum Feb 08

POST OP
Geason 3+3 ,10% both lobes, There is perineurial invasion
No extraprostatic spread seen , Seminal vesicles normal,Nerves spared
Cancer close to apex but margins clear T2c NXMX
Incontinence bad but in April 08- suddenly down to 1 pad
ED - started cialis once every 2 or 3 days from April but no improvement


Frank1205
Regular Member


Date Joined Feb 2008
Total Posts : 308
   Posted 5/1/2008 5:06 PM (GMT -6)   

Positivelife,

I am very similar to you in regards to this.  My family urologist who wanted to do open said he would take it all and save my life.  He said he would take lymph nodes, cut the nerves way back?,and cut the margins wide?  My biopsy seemed to indicate we were early so I got two more opinions from major universities.  Both said totally not necassary,BASED ON THE BIOPSY, which is what everything is based on.  I still dont know why they cant take the prostate out do a quick look at the margins, sample the lymphs and correct if necassary or close.  I have never got a good answer to this question.  Seems like a Lab procedure to me.

Frank


Diagnosed 01-08-08 @ 53 years old 
DRE normal - High PSA for 5 or more years
2004 Biospy negative - 2008 Biopsy positive (01-08-08)
10 cores, 1 positive and at 1% of that one core
Current PSA 6 - Bone and Ct scans negative
clinicalg Staged at T1C - Gleason 3+3 = 6
Robotic Da Vinci performed March 27th, 2008
University of Chicago,5 hour surgery , 3 hour recovery
Unexpected Cardiac issues appear and disappear?
Hospital stay 30 hours - Catheter out in 7 days  normaly expected leakage - Erectile funtion back on line 9 days 
Post Pathology T2C, Gleason 7, 10 % of both portions of prostate, Seminal vessels clear, fat tissue clear,Tumor on bottom of prostate, 1 positve margin  going to meet with oncologist to discuss treatment options if any at this time.
 


DanmanBob
Regular Member


Date Joined Feb 2008
Total Posts : 467
   Posted 5/1/2008 5:17 PM (GMT -6)   
Frank, not sure if I am following your sentences correctly, but some urologists will examine the lymph nodes and if cancer is found, close the patient back up without completing the surgery.  This is a fairly common practice.

Danman Bob, Born 1951
Nerve-sparing, open prostate surgery November 13, 2007
Gleason score 9, PSA 14; Biopsy result - 9 of 12 sticks showed cancer
Post-op pathology stated that cancer was confined to the prostate
Unrelated surgery January 2008 delayed incontinence recovery, which is now showing good signs of improvement (fraction of a pad a day as of late April 2008)
100 MG Viagra 3 times a week beginning December 2007
Osbon Erec-Aid Esteem manual pump for therapy beginning mid-February 2008
30 MG papaverine/1 MG phentolamine bimix injections beginning late April 2008
Five week post-op PSA 0.2, five month post-op PSA 0.1, next test August 2008


positivelife
Regular Member


Date Joined Feb 2008
Total Posts : 42
   Posted 5/1/2008 5:24 PM (GMT -6)   
DanmanBob, as I understand examining of the lymph nodes is done routinely for all open surgery but not for Robotic surgery ?
Dx Age 48 Nov 07

PRE OP
Psa 4.5, Biopsy 2/8 cores positive Gleason 3+3
Wished had done enough research but was in muddy state of mind
Robotic surgery Jan 08

Found Healing Well Forum Feb 08

POST OP
Geason 3+3 ,10% both lobes, There is perineurial invasion
No extraprostatic spread seen , Seminal vesicles normal,Nerves spared
Cancer close to apex but margins clear T2c NXMX
Incontinence bad but in April 08- suddenly down to 1 pad
ED - started cialis once every 2 or 3 days from April but no improvement

1st post op Psa <.1 (May 08)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/1/2008 6:30 PM (GMT -6)   
Not in my case. 10 lymph nodes were removed and biopsied. I have noticed this varies from doctor to doctor not by technique. My doctor takes the nodes as part of his daVinci procedure.

Tony


Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (1/08): <0.1
I will continue HT until May '09. 
Years in Remission (3/23/07): 1
Visit my Journey at:
 
STAY POSITIVE!
 
Prostate Cancer Forum Moderator

Post Edited (TC-LasVegas) : 5/1/2008 6:34:07 PM (GMT-6)


Frank1205
Regular Member


Date Joined Feb 2008
Total Posts : 308
   Posted 5/1/2008 9:22 PM (GMT -6)   

Hi Guys,

Yes this is exactly my interest.  There does not seem to be consistant approach with these lymph nodes.  And those darn margins too.  However I cant remember too many if any on this site that had predicted early cancer where lymph node involvement was found.. In my case I wanted then to look at that prostate, ink it real good and do a preliminary look.

I guess I am just getting the jitters a little .  Got my appointment with the oncologist May 9th..

 


Diagnosed 01-08-08 @ 53 years old 
DRE normal - High PSA for 5 or more years
2004 Biospy negative - 2008 Biopsy positive (01-08-08)
10 cores, 1 positive and at 1% of that one core
Current PSA 6 - Bone and Ct scans negative
clinicalg Staged at T1C - Gleason 3+3 = 6
Robotic Da Vinci performed March 27th, 2008
University of Chicago,5 hour surgery , 3 hour recovery
Unexpected Cardiac issues appear and disappear?
Hospital stay 30 hours - Catheter out in 7 days  normaly expected leakage - Erectile funtion back on line 9 days 
Post Pathology T2C, Gleason 7, 10 % of both portions of prostate, Seminal vessels clear, fat tissue clear,Tumor on bottom of prostate, 1 positve margin  going to meet with oncologist to discuss treatment options if any at this time.
 


DanmanBob
Regular Member


Date Joined Feb 2008
Total Posts : 467
   Posted 5/2/2008 7:42 AM (GMT -6)   

positivelife,

As Frank and TC stated, it varies by doctor and in many cases by the pathology from the pre-surgery biopsy.  When an unaggressive cancer is determined....I do not know the parameters for making the detemination....SOME doctors do not check lymph nodes because the chance of cancer having already spread is considered to be nil.  For more aggressive/advanced cancer, lymph nodes are checked.  Again, it varies by doctor.

 


Danman Bob, Born 1951
Nerve-sparing, open prostate surgery November 13, 2007
Gleason score 9, PSA 14; Biopsy result - 9 of 12 sticks showed cancer
Post-op pathology stated that cancer was confined to the prostate
Unrelated surgery January 2008 delayed incontinence recovery, which is now showing good signs of improvement (fraction of a pad a day as of late April 2008)
100 MG Viagra 3 times a week beginning December 2007
Osbon Erec-Aid Esteem manual pump for therapy beginning mid-February 2008
30 MG papaverine/1 MG phentolamine bimix injections beginning late April 2008
Five week post-op PSA 0.2, five month post-op PSA 0.1, next test August 2008


positivelife
Regular Member


Date Joined Feb 2008
Total Posts : 42
   Posted 5/10/2008 6:15 AM (GMT -6)   
Thanks Dale(livinadream) for starting another topic on Lymph nodes. Thanks to all who made their valuable advice and opinions on this thread on lymph nodes.

For those of us coming to this forum and asking advice on surgery, I think we should advice them strongly to have a good discussion with the surgeon about removal of the lymph nodes. The main reasons are these:

1)Prostectomy is a major surgery, a one time chance of getting the cancer out;why not take the lymph nodes out as well at the same time ? The risk of later spread to lymph nodes is only 1% for the lower gleason grade, organ confined, margins clear successful surgery; nevertheless IT IS STILL A RISK !! You wouldn't want to have a organ confined,clear margin surgery, live with all the side effects, have 0 psa's but still have the possibility of cancer at lymph nodes years down the line.

2)The surgeon decides about lymph nodes mainly based on biopsy results and scans. I read somewhere that lymph node involvement picked up on scans is only 15-30%. As far as the reliability of biopsies, we all know that most often the post op pathology shows higher Gleason scores and higher tumour volume than pre op biopsies and clear margins are quite a lottery. Also the biopsy may say no lympho vascular invasion but the post op pathology may say lympho vascular invasion is there. May be a 30 needle biopsy could help better on deciding about lymph nodes but some people say there is the risk of microscopic spread with such an extensive needling of the prostate.

3)Taking the lymph nodes out during the robotic surgery is an extra 15- 20 mins of operating time. A cynic would say that the less time spent on operations,the more operations that can be done,the more money is there to be had for the medical establishment.

We have to win this battle with prostate cancer. One way is that the new members who are going for a major surgery has all the information beforehand so that they can hope for as clear a cure route as possible. I may may be splitting hairs to accentuate a line of thought, or i could even be incorrect in my reasoning; but opinions from our experienced members would only provide more info for new members seeking advice about surgery.
Dx Age 48 Nov 07
PRE OP
Psa 4.5, Biopsy 2/8 cores positive Gleason 3+3
No perineural or lymphovascular invasion in the biopsy specimen.
Rushed to Robotic surgery Jan 08

POST OP
Geason 3+3 ,10% both lobes, There is perineurial invasion
No extraprostatic spread seen , Seminal vesicles normal,Nerves spared
Cancer close to apex but margins clear T2c NXMX
Incontinence bad but in April 08- suddenly down to 1 pad
ED - started cialis once every 2 or 3 days from April but no improvement
1st post op Psa <.1 (May 08)


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 5/10/2008 6:33 AM (GMT -6)   
this has been a great thread. It seems to me like there is no good reason not to do a lymph node disection as proper protocol during surgery. It would certainly give some men a peace of mind. We just have to keep educating ourselves and take control of our health.

peace and love to all
dale
My PSA at diagnosis was 16.3
age 46 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
 


ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 825
   Posted 5/10/2008 1:14 PM (GMT -6)   
I just spoke with my surgeon at Ohio State and he said they always remove the lymph nodes.  Standard practice during any RP open or robotic.  However, he only does robitic.

biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1464
   Posted 5/10/2008 1:42 PM (GMT -6)   
My surgeon removed and sent some of the lymph nodes to be analyzed during the operation. (I get they went out for coffee till the report came back.) The result was negative so they proceeded with the surgery.
Age 73. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Catheter out on 12/13/06.  Dry on 12/14/06.
Pathological stage: T2C N0 MX. Gleason 3+4.
50 mg Viagra + 1000 mg L-Arginine + .03 cc Trimix = Excellent Results
PSAs from  1/3/07 - 1/17/08 0.00. 
Next PSA test on 7/17/08
"Patience is essential, attitude is everything."

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