lymph node question

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Navy corpsman
Regular Member


Date Joined Aug 2008
Total Posts : 61
   Posted 8/12/2008 6:39 AM (GMT -7)   
During my RRP 22 lymph nodes were removed. I was not aware that the doctor was going to remove them.  Is it normal to have lymph nodes removed during an RRP?  What problems down the road do you think I might have from having so many lymph nodes removed?
Age:  44
We have a family history of PCa.  My Dad and uncle died from it at 65 and 53. My PSA velocity increased in the last 2 years and I had to talk my GP into refering me to a urologist.
Biopsy results:  5 of 11 cores positive, all 30%. Gleason 6. T1c. PSA 2.53  Date of biopsy 15MAY08.
Open RRP at Johns Hopkins with Dr. Partin on 09JUL08.
Pathology report:  Gleason 6, pT2, neg. margins, 0 lymph node and seminal vessical, organ confined, I lost 1 nerve bundle and 22 lymph nodes.
As of today, about a month after surgery, I feel at about 80%. Urinary control seems to be improving. Little Elvis has taken a nap and has not awakened yet. I hope when he wakes up he is well rested because he is going to get one heck of a workout.
 
 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 8/12/2008 7:52 AM (GMT -7)   
I think it is fairly standard procedure, mine were removed.  One purpose is removing any possible pathways from the prostate out into the body, and also for examination during the post-surgical pathology report for determining Gleason Scale, and to detect any cancer cells outside the prostate. As to the number and future effects, I don't know...



James C.
Co-Moderator- Prostate Cancer Forum

Age 61
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 (open) Retropubic Radical Prostatectomy performed
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
10/15/07 ED- begin 50mg Viagra and Vacurect pump nightly, Fully continent
1/14/08 Caverject started/stopped, aching. 2/24/08 .5ml Bimix started-success
7/31/08 ED- Viagra, pump continues, no response- Trimix .10ml x 2 weekly continues
Post Surgery PSA's:  3 mts-0, 6 mts.-0, 9 mts.-0.


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 8/12/2008 8:06 AM (GMT -7)   
I believe that one of the benefits of having an open RRP is the ability to remove the lymph nodes. It is more difficult to obtain the lymph nodes during the DaVinci. My father had lymph nodes removed and one was positive, therefore, we were very grateful to know that he did have involvement beyond the prostate and were able to treat aggressively. His margins were clear with the exception of one focally positive margin, therefore, we wouldn't have suspected ln involvement had the nodes not been removed. In addition his MRI was negative for ln involvement prior to his procedure, so it was quite the shock. In my personal opinion, I would prefer to have them removed and have the piece of mind that they were negative. The only way to really know is by removing the ln. So, you probably had more ln removed than most, but hopefully it was worth it! Best to you in your recovery!
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


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2268
   Posted 8/12/2008 9:32 AM (GMT -7)   

I, too, had open surgery.  Your surgeon, Alan Partin at JHU, has a reputation as one of the best prostatectomists in the US.  I had lymph nodes removed, but only a few near the prostate gland, on the outside chance the cancer had spread.  Thankfully, it had not, and I am cancer free two years later. 

P.S.  Doubtless I will continue to be PSA-tested after age 75, if alive, despite recommendations to the contrary from a national medical committee


Age 59  PSA quadrupled in 1 yr (0.6 to 2.5) 
DRE neg  1 of 12 biopsies pos (< 5%) 
Open surgery June 2006 
Organ confined pT2a  Gleason 5   
Cancer-free for 2 years  PSA's undetectable 


Mbshine
Regular Member


Date Joined Aug 2008
Total Posts : 67
   Posted 8/12/2008 10:19 AM (GMT -7)   
In my current state of shock and search for knowledge, a leading "open" urological surgeon and a colleague of his who is an oncologist and gastro-instest specialist told me that "a trend in the literature and practice" is NOT to touch the lymph nodes if PSAs are UNDER 10.5....since I basically know nothing, others in this forum can perhaps enlighten us....

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 8/12/2008 12:00 PM (GMT -7)   
I haven't heard of any study either way stating a value to do it.  I suppose it is part of the protocol of surgery to do so for most docs.  Mine took 5 lymph nodes.  He said it removing and examining them provided a good marker for the pathology lab to examine and were considered as part of the margins exam. 

James C.
Co-Moderator- Prostate Cancer Forum

Age 61
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 (open) Retropubic Radical Prostatectomy performed
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
10/15/07 ED- begin 50mg Viagra and Vacurect pump nightly, Fully continent
1/14/08 Caverject started/stopped, aching. 2/24/08 .5ml Bimix started-success
7/31/08 ED- Viagra, pump continues, no response- Trimix .10ml x 2 weekly continues
Post Surgery PSA's:  3 mts-0, 6 mts.-0, 9 mts.-0.


Bluenose
Regular Member


Date Joined May 2008
Total Posts : 260
   Posted 8/12/2008 12:47 PM (GMT -7)   

 

  ..at first my Dr. was unsure if he would take any of mine or not, said his normal cut-off(no pun intended) was at the G6 mark, with me being a G7 he went ahead and took some of mine closet to the prostate( I think it was five too)....that is why I was sent home with the JP drain still in place he told me....I'm glad he checked them out...


 
   age: 53
   Pre-0p PSA  Feb. 08, 5.0
      4.22.08, 4.1
      PSA  spiked once about 8yrs ago to 5.0 three months later
      back to 2.9...then into the 1.2 range until my re-scheduled 
      "missed" appointment this past Feb.
      Biopsy 5.1.08 
      Gleason-3+4=7
      T2a
      5 of 15 cores positive
      Da Vinci scheduled..7.29.08..as I read somewhere on this 
      site....."the first show of the day"
       DaVinci completed 7.29.08, Bladder Sling installed, hernia repair 
       completed during surgery.    
       3hrs in surgery, 2 in recovery...trouble starting the airway pre-
       surgery.
        Sent home 30hrs,  JP drain in place 7days, catheter remains..
       Path report "cancer fully contained"....Margins clear
        Cath removed 8.8.08(ten days)...one lightly used pad 24 hours
        ED therapy begins 8.9.08. 100mg viagra three times a week,
        pump everyday and hold for ten minutes.
 
        "just tryin' to reason with hurricane season"....


MURPHY1
New Member


Date Joined Apr 2008
Total Posts : 12
   Posted 8/12/2008 3:00 PM (GMT -7)   
Our doctor did not remove any lymphnodes because the original biopsy showed very little involvement, gleason 6, etc but now that the cancer seems to be more involved and more aggresive he said that he wishes that he would have taken nodes and that too many of his patients pathology has changed after surgery that he thinks he will now make it standard procedure.. I wish that he would have taken them so that we would have more info!!
husband diagnosed May 2008
PSA 4.4
age 47
biopsy showed less than 2% involvement
gleason 6  3+3
Davinci Surgery 7/21/2008 Dr. Shalhav University of Chicago
home 7/22/2008 -
Biopsy results - 40% involvement, gleason 3+4 = 7 with small focus of gleason 5,  small margin on right side
incontinence - minimal, ED - 95% with viagra


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 8/12/2008 3:06 PM (GMT -7)   

I can't speak for everyone but I personally knew prior to surgery that I was going to have a lymph node disection and I agreed to it. Thank goodness I did because that was the only way I know that they could have found the cancer. When you are dealing with an enemy like cancer I think you should use all measures available to find exactly where it is. To me it is one of those things to where if your doctor did not do it and a year down the road you cancer has spread you will wonder why he didn't do it. To me a lymph node disection is minor compared to not doing it. Obviously for me it meant life and death so I have a different opinion than most.

Please stay in touch

peace and love

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
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
cancer in 4 of 6 cores
92%
80%
37%
28%
 


JCL
Regular Member


Date Joined Jul 2007
Total Posts : 242
   Posted 8/12/2008 3:37 PM (GMT -7)   
My lymph nodes were spared. My surgeon told me it was standard practice for him only if it appeared from the biopsy results that there was a high chance that the cancer was contained. If the biopsy shows a potentially advanced and aggressive cancer then he removes them.
Biopsy: Diagnosed March 25, 2007. PSA 3.0. Gleason 6. Five of twelve samples positive with <5% each. No perineural invasion seen.
Surgery: May 21, 2007, Florida Hospital, Orlando,FL
Post-op Pathology: Upgraded to Gleason 7 (3+4), negative margins, negative capsular penetration, negative seminal vesicles, lymph nodes left intact, multifocal perinural invasion, 15% of prosate involving cancer in both lobes. T2c
Continence/Erections Out of pads at five weeks. Fully continent and can achieve erections.
Post Surgery PSA: Five tests, all <0.1
Family history: Great-great grandfather died from PC. My Father had his prostate removed at age 67 in 1997 and has had an undetectable PSA ever since. I was diagnosed at a much earlier age and had a more agressive cancer than my father. Go figure.


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/12/2008 5:11 PM (GMT -7)   
Navy,
22 seems like a lot. But I am not surprised. I am amazed when lymph nodes, at least in the pelvic region, are NOT dissected. But some surgeons don't do it at all. In fact, some big name surgeons don't do it and many big name surgeons always do it. I am not sure why that is. But there are enough studies showing that lymph node disection is an important part of surgical prostatectomy. Any involvement could change the post operative treatment options drastically. My surgeon removed 10 pelvic lymph nodes.

There is also some evidence that removing additional lymph nodes in stage III and IV cases has a postive effect on results. Dr. Snuffy Myers writes that he was diagnosed stage IV and had what he called a Lymphectomy even though his prostate was inoperable. I can see the logic to this if bone mets are not present. Myers has written well known books and essays on it, and he is doing well ten years later. I wonder how many stage III and stage IV guys here that did not have any removed might want to consider asking about doing a lymphectomy?

My surgeon just does this in his practice. I think if I were to do this all over again (once is enough) knowing what I do now, I would request that the doctor did remove at least the pelvic region nodes as mine did. It hasn't caused me any issues, and it was good to know, especially in my case, that the nodes were clean.

Tony
Age 46 (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 (May 9 '08): <0.1
I will continue HT until May '09. 
Years in Remission (3/23/07): 1
Visit my Journey at:
And at:
 
STAY POSITIVE!
 
 


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1131
   Posted 8/12/2008 7:36 PM (GMT -7)   
i only had one removed. wish i had known to ask the surgeon before surgery how many he planned on removing.
 
Age 48
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
decision - surgery (robotic)
surgery may 9, 2008 - houston, tx
pathology report -gleason 8
margins clear
4 week and 6 week PSA >.04 (undetectible)
12 week PSA <.04
continent at 10 weeks (no pads!)
kegel's twice a day 20 reps


Navy corpsman
Regular Member


Date Joined Aug 2008
Total Posts : 61
   Posted 8/13/2008 7:28 AM (GMT -7)   

Thanks for all the replies.

Does anyone understand the effect on the lymph system when lymph nodes are removed from it ?

- John
Age:  44
We have a family history of PCa.  My Dad and uncle died from it at 65 and 53. My PSA velocity increased in the last 2 years and I had to talk my GP into refering me to a urologist.
Biopsy results:  5 of 11 cores positive, all 30%. Gleason 6. T1c. PSA 2.53  Date of biopsy 15MAY08.
Open RRP at Johns Hopkins with Dr. Partin on 09JUL08.
Pathology report:  Gleason 6, pT2, neg. margins, 0 lymph node and seminal vessical, organ confined, I lost 1 nerve bundle and 22 lymph nodes.
As of today, about a month after surgery, I feel at about 80%. Urinary control seems to be improving. Little Elvis has taken a nap and has not awakened yet. I hope when he wakes up he is well rested because he is going to get one heck of a workout.
 
 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 8/13/2008 9:33 AM (GMT -7)   

John, here's a laymans description of it

 
James C.
Co-Moderator- Prostate Cancer Forum

Age 61
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 (open) Retropubic Radical Prostatectomy performed
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
10/15/07 ED- begin 50mg Viagra and Vacurect pump nightly, Fully continent
1/14/08 Caverject started/stopped, aching. 2/24/08 .5ml Bimix started-success
7/31/08 ED- Viagra, pump continues, no response- Trimix .10ml x 2 weekly continues
Post Surgery PSA's:  3 mts-0, 6 mts.-0, 9 mts.-0.


B&B's World
Regular Member


Date Joined Mar 2007
Total Posts : 120
   Posted 8/29/2008 9:26 PM (GMT -7)   
I was quite adament that lymph nodes NOT be removed during surgery, with concern over lymphadema. Our doctor stated unequivocally that there is no need to remove lymph nodes, as PSA says it all.  With prostate cancer, if you have significant PSA after surgery then you still have a problem.  You do not need to remove lymph nodes to find out, like with other cancers.  That being said, we found out that there was a lymph node removed during B's surgery.  Turns out, there was one in the fatty tissue, not recognized as such until it was removed with the prostate.  So be it.  I had an aunt with breast cancer who suffered greatly from from lymphadema after having lymph glands removed.  I would avoid it if at all possible.

Age 51

Gleason 3+3

PSA from 3.2 to 4.3 in one yr

Biopsy 11/06

DRE negative

4 of 12 cores positive, one lobe, less than 10%

Inflammation only second lobe

Stage T1C Clinical Dx

PSA prior to surgery: 3.9

Da Vinci Prostatectomy 2/27/07:

PCa in BOTH lobes 5-10% of gland

Gleason 3+3

Negative tissue margins

Bladder, seminal ves, vas deferntia negative

Two inguinal hernia repairs

Catheter removed 1 wk after surgery

Full continence (no pad needed) 1 wk after surgery, then intermittent drips 4 wks out

Full erection, 12th day after surgery

2 mo’s post-op, some ED after penetration

3 month PSA 0.03

6 month PSA non-existent

1 year   PSA  non-existent

1 1/2 yr PSA  non-existent

Erectile function--up and running!

 


Jetlagged
Regular Member


Date Joined Jul 2008
Total Posts : 29
   Posted 8/30/2008 7:14 AM (GMT -7)   
They took 18 from me, which considering they were clean was a great relief. I think they grab as many as they can while they're there, and I would have been upset if they didn't take some.
Robotic RP 12/07
Age 46
Pre-surgical PSA 5.02
Bone scan/Chest X-ray clear
All margins, seminal vesicles, 17 lymphs clear
3+4=7
Three Post-surgical PSA's <0.01


B&B's World
Regular Member


Date Joined Mar 2007
Total Posts : 120
   Posted 8/30/2008 9:49 AM (GMT -7)   
I would say, check again, regarding the removal of lymph nodes. They used to do it, but protocol is changing now. Bear in mind that the lymph system is still not well understood. My sister, the RN nurse supervisior and teacher at a major hospital informs me that medical community is recognizing the fact that the lymph system is part of what fights cancer in the human body. And I will state again that Dr. Thomas Ahlering, the top urologist at UC Irvine, where they developed the Da Vinci equipment for robotic assisted surgery, does not routinely remove lymph nodes.

Age 51

Gleason 3+3

PSA from 3.2 to 4.3 in one yr

Biopsy 11/06

DRE negative

4 of 12 cores positive, one lobe, less than 10%

Inflammation only second lobe

Stage T1C Clinical Dx

PSA prior to surgery: 3.9

Da Vinci Prostatectomy 2/27/07:

PCa in BOTH lobes 5-10% of gland

Gleason 3+3

Negative tissue margins

Bladder, seminal ves, vas deferntia negative

Two inguinal hernia repairs

Catheter removed 1 wk after surgery

Full continence (no pad needed) 1 wk after surgery, then intermittent drips 4 wks out

Full erection, 12th day after surgery

2 mo’s post-op, some ED after penetration

3 month PSA 0.03

6 month PSA non-existent

1 year   PSA  non-existent

1 1/2 yr PSA  non-existent

Erectile function--up and running!

 


leaky
New Member


Date Joined Mar 2008
Total Posts : 15
   Posted 8/31/2008 1:11 PM (GMT -7)   
Hi Navy,

Lymph node removal not discussed prior to surgery. I'm considerably older than you and have suffered severe edema since surgery--never before. Thigh high compression hose and sleeping with legs elevated control the problem.

Best,
70 when diagnosed in 10/2004, open surgery 12/2004, margins clear, pre surgery PSA 6.4, 3+4=7, cancer from apex to base left side, 30 gm prostate, right nerves spared, seminal vesicles & lymph nodes (6) removed.

ED & incontinence problems since surgery, life changing & indescribable unless you have experienced it.

Advance male sling 03/2004, AUS and IPP scheduled 10/2004. All work done at UT Southwestern in Dallas.

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