Lymphatic question

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Regular Member

Date Joined Jan 2010
Total Posts : 28
   Posted 4/28/2010 9:29 AM (GMT -6)   
Are periprostatic lymphatic spaces the same as pelvic lymph node concerns. My pathology report notes lymphatic invasion in periprostatic lymphatic spaces, but none of my doctors, and I'm working with a few, have mentioned that specifically, although they've discussed everything else in the report with me including what they believe to be no pelvic lymph node issues that they can detect, (2 CT scans plus visual at surgery) Since they haven't brought it up I haven't asked, I'm kind of afraid of what I might hear. What exactly does it mean, how big a deal is it? What's its relationship with the larger pelvic lymph node concerns?
As this journey continues and PSA now detectable at 6 mo. out, the docs at this point have unanimously recommended radiation treatments, so I'm going to go for it and do it, probably at the beginning of summer. Even before surgery each doc I spoke to had pointed out the possibility of radiation post surgery, so from that respect it is just another shoe dropping. We're waiting for one more 6 wk PSA, meet with uro and rad doc again in May and then move ahead.
As always, advice and help here most appreciated.
60 year old, sometimes happy, sometimes grumpy guy
Robotic RP 11/09
Otherwise good health
Gleason 8, T3a
Margins uninvolved
extraprostatic extension present,
Seminal vesticle invasion: absent
Apical and bladder neck margins-clear
One nerve bundle spared, you'd never know it yet.
PSA 1/25/10 <.1
4/12/10 0.1
Bone scan, CT scan 4/10 neg
Great support, wife, family, employer

Regular Member

Date Joined Mar 2010
Total Posts : 495
   Posted 4/28/2010 1:47 PM (GMT -6)   
I do not know what to say about your periprostatic lymphatic spaces. Greater than that is that I believe the super sensitive psa will be the key issue and whatever is in those spaces will be addressed by the radiation. Your radiation is necessary because of psa and Gleason and you should have the lymph nodes addressed as well as the prostate bed.
Will the radiation be with hormone adjuvant? Why, or not?
Your situation is not unusual, though it is unique for you.
You are still in the driver seat.

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4268
   Posted 4/28/2010 3:47 PM (GMT -6)   
English teacher,
I don't know what periprostatic lymphatic spaces are, but I do know that scans and even surgical removal of lymphnodes is a very innacurate way to discover lymphnode mets, especially with a low psa.
It is also a high probability that your doctors don't know and are just guessing (at your expense).
I would go on prostate pointers P2P and ask Dr Strum what it means. A phone consultation with Drs Scholz or Myers would also be good options. Find out from an oncologist that specializes in only prostate cancer. If PC has invaded the lymphatic system in anyway it must be considered systemic and you need to know this before you undergo another local treatment that may not be effective.
Just for you information, a CT scan can identify a large infected lymphnode at 10mm it cannot identify mico mets. Unless a lymphnode is reviewed pathologically by an expert it is very difficult to determine PC in a node. You can't do it by sight unless it is really bad. Also surgical removal of lymphnodes can identify at best 50% of lymphnode involvement as recent studies in Germany and Holland have uncovered. This is way out of any urologist or radiologist's skill level.

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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