Lymph node inolvement?

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Regular Member

Date Joined Jul 2008
Total Posts : 50
   Posted 7/31/2008 7:09 PM (GMT -6)   
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?

Veteran Member

Date Joined Apr 2008
Total Posts : 1382
   Posted 7/31/2008 8:24 PM (GMT -6)   
Good evening Hopeful, I am a patient at The Cancer Treatment Center of America and I think they are absolutely awesome. As for detecting lymph node involvement acurately I do not know of any way other than a pelvic lymph node disection. There may be other ways, but I am not familiar with it. Pleas contact me via email if you would like and we can discuss CTCA it is a great hospital.

peace and love
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
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
cancer in 4 of 6 cores

Veteran Member

Date Joined Feb 2008
Total Posts : 1858
   Posted 7/31/2008 8:29 PM (GMT -6)   
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.
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
PSA April 08 <0.1 undetectable

Post Edited (BillyMac) : 7/31/2008 8:09:20 PM (GMT-6)

Regular Member

Date Joined Jan 2008
Total Posts : 338
   Posted 7/31/2008 8:52 PM (GMT -6)   

A PET scan will can show tumors in the lymph nodes.  In my case the PET was positive and the Prostascint was negative.

My story is all in my website.

You might want to consider both.

The best to you in your decision making process.


Retired USAF Richard & Debbie on The Shores of Toledo Bend Lake Louisiana
Biospy 1/10/08 Gleason 10, Stage T1C  8 of 12 samples positive all Less Than 5% 
Suspected lymph node involvement
Lupron & Casodek May 08 for 2 years
Completed 25 IMRT and 17 PBRT U of Florida Proton Therapy Institute 7/24/08
PSA .21, free PSA .08, Percent free PSA 38.1, testosterone 14.6
Turn Stumbling Blocks into Steping Stones and Keep Smiling
Our Journey is on WWW.GLEASON10.COM

Regular Member

Date Joined Apr 2008
Total Posts : 270
   Posted 8/1/2008 9:13 AM (GMT -6)   
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

Doting Daughter
Veteran Member

Date Joined Aug 2007
Total Posts : 1064
   Posted 8/1/2008 9:26 AM (GMT -6)   
As many others have previously posted, there are no guarantees.  My family had to learn it the hard way.  My father's MRI came back negative for lymph node involvement, and his odds of lymph node involvment were <.11%.  We were thrilled and very optimistic for good news regarding the post op path report, and were devestated to learn that a lymph node was involved.  We didn't learn until afterwards, the accuracy (or lack of) of the dx tests. 

Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum

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