Pelvic Lymph Node Dissection prior to prostatectomy

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Sunbird
Regular Member


Date Joined Apr 2008
Total Posts : 140
   Posted 1/11/2010 4:53 PM (GMT -6)   
I'd like to know if Pelvic Lymph Node Dissection (PLND)
is a common practice for patients diagnosed with Gleason Six cancer.  I believe I read 13% of patients with Gleason Six will have positive lymph nodes.  If this is true, why don't surgeons remove pelvic lymph nodes for pathology exam, let's say, two weeks before a scheduled prostatectomy if there is any chance cancerous cells have entered the lymph system? 
 
Is there some type of benefit to be gained with removing the prostate gland even if there is a high probability positive nodes will be found during surgery or should a person who feels he may have positive lymph nodes try a different treatment such as chemo/hormonal therapy that would be more systemic in nature?

tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2842
   Posted 1/11/2010 5:08 PM (GMT -6)   
-it was my understanding that for my radical prostatectomy ( with gleason 7) - the surgeon would remove and dissect the lymph nodes and if they were cancerous - stop the operation and then plan another route of attack.
-if they were negative, then continue on with the operation. They were negative and he continued with removal of the prostate, etc.
-I am sure the veterans here will supply you with a more detail analysis.
.................
Age: 54 - gay - with spouse, Steve - 59
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous samples , Gleason 7 (4+3)
Doctor: Dr. Mohamed Elharram -Urologist / Surgeon - Peterborough Regional Health Centre
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Post Surgery Biopsy: pT3a- gleason 7 - extraprostatic extension - perineural invasion - prostate weight - 34.1gm -
ED Prescription: Jan 8/2010 - started daily 5mg cialis
location: Peteborough, Ontario, Canada
............


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 1/11/2010 5:21 PM (GMT -6)   
I think that was more of a common practice a couple of years ago. Today they seem to do it all in one fell swoop.

There is some evidence that survival rates are better even in cases where the PC has escaped if the proatate is removed.

Goodlife
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/11/2010 5:51 PM (GMT -6)   
I looked at doing this back in 2002 ( a couple 8 yrs. ago) U of Mich. surgeon could do it, kind of talked me out of it and maybe for good reasons, I was not hiring him as a surgeon for PCa anyway and he knew that, so probably not to biased an opinion is my guess. He mentioned some risks to legs or normal movement envolving the legs...my case was so ridiculous with PCa that it would not have been that worthy anyway (hindsight).

You could have different lyphmnodes sampled, however in entails some risks like to your legs and such, as a factor to add into the mix. Alot of possible nodes to sample or look at so someone has to decided which and where. In theory it sounds logical and reasonable prior to surgery, but in practice rarely done and the results are I would guess not that excellent as to being a worthy protocol to do, prior to surgery. Otherwise it would be done as such, if not here in the USA, then in other countries we would see this happening, I don't think it is very common.
There are docs whom are doing this and can do this if one happens to feel that strongly about doing it...no certainties with PCa no matter what you do, you might come closer to such. You would have to analyze your own situation as to it being worthwhile.
Youth is wasted on the Young-(W.C. Fields)


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 1/11/2010 6:21 PM (GMT -6)   
as tatt2man said, my surgeon removed 5 of the abdominal lymph nodes during surgery, and this went for a path report, along with all the other parts. He told me that if he found 'gross' evidence of spread beyond the gland that he would not remove the prostate. I didn't agree with that approach then, and today I would very strongly disagree with it, knowing what I do now.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
24 mts: PSA's: .04 each test since surgery, ED Continues-Bimix .3ml PRN or Trimix .15ml PRN


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4226
   Posted 1/11/2010 6:45 PM (GMT -6)   

Unlesss you have a high psa which would indicate lymphnode involvement, it would not be a good idea to have your lymphnodes removed as there could be some serious side affects. Higher gleason grades which have more chance of spreading may have lymphnode dissection.

Recent studies have shown that lymphnode dissection misses 50% of the lymphnode cancers as only the nodes near the prostate in the pelvic area are sampled. Spread through the seminal vesicles to the other lymphatic path would not be sampled.

A high psa is indicative of lymphnode PC and norma treatment is to radiate the lymphnodes. The other option is to get a Combidex MRI to identify individual lymphnodes to be targeted by radiation. CT scan which are normally recommended can only pick up infected nodes greater than 10mm or billions of PC cancer cells.

JT


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.

JohnT


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 1/11/2010 7:28 PM (GMT -6)   
The protocol my surgeon used was during the surgery he would remove several pelvic lymph nodes and if two were cancerous he would abort the surgery. In my case I had three and now 30 months later I still have a prostate. In hind sight I think I would have rather them remove the prostate anyway.

peace to you
dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) 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
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11

Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%


brainsurgeon
Regular Member


Date Joined Jul 2009
Total Posts : 137
   Posted 1/12/2010 6:58 AM (GMT -6)   
My surgeon told me that in his series he had found a 25% chance of micro-metastases to pelvic lymph nodes even in the face of negative CT and Bone Scans. He removed 13 nodes with my blessing. I suppose these micro-mets could account for some of the SRT needed, but who knows? The pelvic dissection is no walk in the park for the surgeon, and I suppose some or all, of my neurpraxia (now 90% gone) could have been a result. To me, it just meant that I had a doc who wanted to do the best job possible.
70 years old (1939) USA citizen
Prostatic carcinoma dxed June 2009 by PSA (7.0) and then Bx
PSAs yearly since 2001 ranged 1.52 to 7.0
Neg. CT and Bone Scan
4 of 8 biopsies positive (all right side) Gleason Score 3+4=7
Robotic assisted total prostatectomy and node excision July 2009 in Luzern, Switzerland by Dr. A. Mattei in the Kantonsspital
pT2c G3 pN0 (0/14)
Catheter out in 5 days (home in 3 days)
No incontinence
Positional neurpraxia resolved in 5 months.
Potency: beginning tumescence??? at 3 weeks post-op. Still happens at 3 months PO. Nearly usable one month later. At 5 mo. with 100 mg Vitamin V, pretty good.
3month PSA less than 0.01

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