HELP PLEASE--lymphectomy without removing prostate?

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New Member

Date Joined Nov 2009
Total Posts : 5
   Posted 12/6/2009 10:15 PM (GMT -6)   
Is it the norm to remove lymph nodes and not remove the prostate?
should he be getting hormones right now or are all these tests nessesary first isnt it dangerous to be taking so much time since DX?

Hi I am wife of hubby 63 who is in great health except for PC.
he was diagnosed w/aggressive PCa 2 months ago at VAMC. he has Gleason 9 and t2c or t3a still getting tests done between VA and private Dr.s
he has had bone scan- ct scan and needle biopsy of enlarged lymph node all supposedly negative. saw private urologist today he says he wont do radical prosectomy because to advanced but after bloodwork results for alk/phosphate gets back and he does a cystoscopy in 10 days he would do removal of lymph nodes around prostate and then have a radiologist do hormone therapy and IMRT radiation for 7 weeks.

VA has him scheduled for April 27th for radical prosectomy. seems to us that is to long to wait and also contradicts the private Dr's here in treating this. his biopsy in Oct 09 was 7 positive out of 10 plugs they are 4+3 =7- 5+4+=9 - 5+4=9 - 4+3=7 - 4+4=8- 4+4=8 4+4=8.

Va pays all if we use them but they are to slow and frankly beginning to feel they are not handling this properly. also afraid of radiation but like the sounds of proton therapy. so are waiting to hear back from LLUMC. but they have a waiting list til mid Feb.

i feel we are really getting limited in choices and time. any help on this asap would be very appreciated. Don't know how much more time we can spend on researching and waiting before it goes to stage 4. Every time we think we are getting somewhere we are told to get a different test and then have to wait and so on and so on. and everything is wait wait wait thanks, jan

Veteran Member

Date Joined Jul 2006
Total Posts : 669
   Posted 12/6/2009 11:05 PM (GMT -6)   

I have not read accounts from many men here who had the lymphadenectomy performed.  It is often done because the diagnosis is so agressive that the urologist feels that prostate removal will not be enough and  they should go right to more extreme treatments such as radiation. 

It appears that might be your husbands diagnosis.  That being the case, consult again with your private urologist and follow his recommendations.  I would NOT wait until April 2010 for treatment.  That is too long to wait.  I suspect the lymphadenectomy is being suggestted to get a more complete diagnosis and confirm the need for quick treatment

Don't be afraid of radiation or proton, that might be your best treatment for this diagnosis.  Maybe Loma Linda can get you moved up the list.  I'm sure you will get more suggestions from others on this forum. 

It is time to stop the waiting and demand action from your doctors.  Good luck with your husbands treatment.

PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06 ,stageT2A
Very Aggressive Gleason 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8 with no extension or invasion
no long term continence problems
Post surgery PSA continues to be "undetectable"
One side nerves spared
Bi-Mix for ED 
born in 1941

Veteran Member

Date Joined Mar 2009
Total Posts : 739
   Posted 12/7/2009 12:10 AM (GMT -6)   
Hi Jan,
I sure help is on its way, we have some very experienced guys on this forum, all I can say from my limited knowledge, is not to wait any further.  My thoughts are we you and hubby.
Age 51yrs
6 out of 8 cores positive 3 X 60% / 3 X 10%
Gleason Score 3+4=7
Stage T1c
Robotic Surgery 24/12/08
Upgrade Gleason Score 4+3=7 Gleason Differential 60%/40%
Stage T2c
Three small foci total volume <10%
Neg Margins and Nodes
Nil - Extraprostatic Extentions
Dry less than 1 week.
ED- taking Meds- Its been 9 mnths now getting some action ! yay !
PSA 1/09  .03
PSA 2/09  .03
PSA 5/09  .03
PSA 9/09  .03
"Everyday in Everyway I get better"

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 12/7/2009 12:11 AM (GMT -6)   
Hi Jan,
Welcome to HealingWell. I am sorry your husband has joined our ranks, but what you are doing now is helping him. I have to be frank, his biopsy results are not that good. Additionally, Loma Linda may not be his best option right now. You should start looking into an hematological approach with a medical oncologist. Are you in the Los Angeles area?

Please note that your husband can still get a good handle on this and outlive this illness. I am seriously suggesting that with his numbers in the pathology report, that he should pick a better starting point than with a surgeon or radiologist. These are still options, but only after a better analysis of where things are now.

Prostate Cancer Forum Co-Moderator

Post Edited (TC-LasVegas) : 12/6/2009 11:43:13 PM (GMT-7)

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 12/7/2009 5:51 AM (GMT -6)   
First of all question the lymphedectomy, it can be done but has risks for permanent side effects and is not normally done even as investigative work. During a surgery a sampling of lymphnodes should take place for reasons you can read about.

Considering your stats of which I had comparable and similar and more positive cores (all 12), but only had some of the gleason 5's as second number in the scoring (in others words less of it than they found in yours via percentages). There are alot of ways to combat and fight PCa, all roads can lead to Rome or help with control or towards cures. So no one answer from myself or anybody is the only way to go on this.

Now you could look at the Bolla study abstract, even though you are a high risk patient (failure is more likely), you could do ADT2 or 3 (combo drug therapy) 6 months or so prior to doing radiations (IMRT-Photon or Proton or Neutron/Photon) and continue on ADT1 to 3 drugs and monitor your psa's. This combo should give you a reasonable control over the PCa, you would be most fortunate if it turned into super long time or cure. Brachy seeds and radiations along with ADT would be similar concept.

You could also do ADT2 or 3 as your only treatment or some related drug therapies of which there are many choices and possible to switch from one to another and get new responses if you fail on one or the other.

You should have some doc putting you on some type of drug therapy asap for slowing it down while you wait and look at everything, your can do surgery if that is your choice(unlikely any primary treatment is a cure). If you need immediate help on that front or other questions from a patient that is and has walked your type of road, click on my screen name for email address.

Dx-2002 (Feb-Mar), bpsa 46.6 12/12 biopsies all 75-95%, gleasons found 7,8,9's (two sets) the nines were (4+5)=9 versions, ct and bone scans clear, ADT3 + bolla concept, dropped ADT3 (2005)went to DES only, psa for the last 4 yrs. between .36-1.3, psa Nov 30 .8

Post Edited (zufus) : 12/7/2009 5:23:46 AM (GMT-7)

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 12/7/2009 10:33 AM (GMT -6)   
I believe that many surgeons, especially in high risk cases, will dissect the lymph nodes before proceeding with the prostatectomy. Thus making the procedure a lymphedectomy. It's important to note that in Dr. Snuffy Myers case he has the lymphedectomy and he recommends it in his protocols for some patients.

It may have side effects but nothing like a prostatectomy. But first a better analysis is prudent in Jan's husbands case.

What is his current PSA? He may have some time still to do more tests. I don't doubt he is headed for hormone therapy of some sort. If you are in the LA area, then you have UCLA or UCI as great cancer centers. There is a specialist in prostate oncology in Marina Del Rey...

Prostate Cancer Forum Co-Moderator

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 12/7/2009 12:11 PM (GMT -6)   
TC- no disagreement with you and Jan can look into alot of things. I know that about surgery and sampling (and one surgeon at our meeting sometimes doesn't sample even then at surgery, as they should) I hoped it was understood above, I am talking about sampling nodes without surgery for PCa, I looked into that too through U of M, side effect issues made it look more complex, etc. It can be done and is a possible choice, anyone looking at doing such, should try to find out anything they can as to side effects and risks and reasonable success of using such a method.

You were saying that Dr. Meyers might use this in select patients, it makes some sense to consider it on a logical basis, without knowing alot about PCa, apparently it isn't that great of a tool or we would see it being used heavily.

Keep Rockin-TC (we both like our six strings!)

New Member

Date Joined Nov 2009
Total Posts : 5
   Posted 12/8/2009 7:23 PM (GMT -6)   
Hello everyone and thanks for your input.

TC asked what his psa was--- it was 12.7 end of May 09 percent free psa =12 and psa free=1.58 and July 15/09 psa was 9.8 it went down but he had been in antibiotics for bladder infections which he gets alot. he hasnt had a psa test since then that i can find- just a bunch of tests. And yes you are right about the Radical prostatectomy he definitely doesnt want the surgery after learning he would probably have to have salvage radiation and hormones anyway. and if they discover it is not as advanced after the cysto ( NEXT WEEK and lymphectomy (NOT SCHEDULED YET) he still wants the Proton surgery even if he was a Gleason 4

one good thing about this all takeing so long it has allowed us to investigate more our options and the side affects.!

Loma linda just called and had a few questions, Dr is still going over the stuff i sent last week. kind of irritating as what they wanted to know is what i had sent. DO THEY NOT READ THE MED RECORDS??????????
the woman said if they take him they would want him on hormones for 2 months and then would do Proton and then regular radiation n that order.. I asked if he should get hormones immediately and she said no to wait till other tests are done.
since talking to them just last week they are now out till March for treatment, so dont know if we can afford to wait for Proton and just have to go with IMRT. I am so bummed. just praying his bladder test comes back Ok.

Oh and we are in Oregon. Thanks Jan

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4170
   Posted 12/8/2009 8:03 PM (GMT -6)   
If you are in Ore try to get a consultation with Stephen Strum in Ashland Ore, He's the best oncologist around. He'll give you the straight scoop.

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.


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