Correct number of lymph nodes to be taken during surgery

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TTaylor
Regular Member


Date Joined Nov 2010
Total Posts : 102
   Posted 11/30/2010 7:51 PM (GMT -6)   
Does anyone have a feel for the correct number of lymph nodes that should be taken during a DaVinci Prostectomy? My urology surgeon took only one, and a friend of mind that is a urologist said that was inadequate. I questioned my surgeon and he said he took a rather large tissue sample that had only one lymph node in it. He also said you couldn't see lymph nodes unless they were large. I have seen documentation on this post where as many as 18 lymph nodes were taken. It's to late to go back, but I feel like my surgeon  maybe didn't take enough. Fortunately that one lymph node was clear however being a Gleason 8 with adipose tissue invasion and perinural invasion I am concerned my Dr. did not cover his bases adequately.
TTaylor

proscapt
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Date Joined Aug 2010
Total Posts : 644
   Posted 11/30/2010 9:24 PM (GMT -6)   
From what I understand there is a wide variation in practice, depending both on the doc and on the assessment of risk based on biopsy info and PSA. At my DaVinci RP they didn't take any. I was surprised by that, and I asked the doc (a well-regarded doc at a major center) why not. He said they stratify based on risk level. I had a capra score of 3, and they don't take lymph nodes for a capra of 1,2, or 3 since the probability of lymph node invasion is less than 3% for those scores. (3 is the low end of the intermediate range)

You can compute your own capra here:
http://urology.ucsf.edu/patientGuides/uroOncPt_Assess.html
This was invented at UC San Francisco Medical Center.

Taking a lot of lymph nodes sometimes has its own side effects and complications, so they don't like to take a lot if the preliminary evidence suggests a localized cancer.

That said, Walsh's book says they always take at least some lymph nodes.

Other research I reviewed said it's more difficult to take a lot of lymph nodes robotically than with conventional surgery and as a result fewer lymph nodes will be taken, for a given level of risk.

Arnie
Regular Member


Date Joined Aug 2009
Total Posts : 374
   Posted 11/30/2010 9:40 PM (GMT -6)   
I calculated my Capra score and it came out to 1 (Thanks, Proscapt, I had never heard of the Capra score before this)
That said, I still had one lymph node taken during my Davinci surgery in 1/09..........I, too, have seen the number taken vary among our members here.
 
Arnie in DE

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 11/30/2010 10:13 PM (GMT -6)   
proscapt answer is what I was told by my uro/surgeon, and as a rule, in an open procedure, its generally easier to take more lymph nodes if needed, as opposed to Robotic surgery. In my own surgery, the doctor said he was able to feel the lymph nodes on the suspected side, and didnt remove any more then he felt was safe, as taking out a lot of them can add to complications and infections.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

goodlife
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Date Joined May 2009
Total Posts : 2692
   Posted 11/30/2010 10:29 PM (GMT -6)   
I don't believe it has anything to do with open or robotic, but mainly the overall risk of systemic involvement.  PSA, biopsy results, DRE, EPE, margins, etc.  My surgeon took out 23 robotically.
 
Some doctors also apparenty aren't as concernedas others.  With a Gleason 9, I was thankful he was so thourogh.
 
Goodlife

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7078
   Posted 11/30/2010 10:47 PM (GMT -6)   
Did my score - came out at 6. They took 12 lymph nodes in my DaVinci surgery.

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2460
   Posted 11/30/2010 11:20 PM (GMT -6)   
I asked my doctor why he didn't test the lymph node and his answer was that because of my low PSA prior to surgery and the way the lymph nodes looked and felt to him there was only a 5% chance that the cancer has spread to the nodes.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18 months) undetectable
Latest PSA test (21 months) .005

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 11/30/2010 11:46 PM (GMT -6)   
I was a G7 and had 9 nodes taken. never asked why
Dx PCa Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4) - 8 cores, 4 positive, 30% of all 4 cores.
Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%, nerves spared, no negitive side effects of surgery.
PSA's < .01, .01, .07, .28, .50. HT 5/10. IMRT 9/10.
PSA's post HT .01, < .01

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/1/2010 10:45 AM (GMT -6)   
I had a much simpler explanation. My surgeon took out ten (6 on the left, 4 on the right) because that was how many he found during the procedure. He did not go exploring for them. The differing counts will depend on anatomy not preference. No two bodies are alike.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

NEIrish
Regular Member


Date Joined Aug 2010
Total Posts : 245
   Posted 12/1/2010 11:04 AM (GMT -6)   
We never questioned the doc on the number of lymph nodes taken. My husband had a Capra score of 1, very low risk, yet 10 lymph nodes were removed from the right pelvic region, 2 from the left. We assumed it was because his initial biopsy found the cancer on the right side. The number of things we haven't questioned or don't know yet still amazes me. Since he is of the mind that the surgery is over and subsequent PSA's zero club qualification, he doesn't care. I'm more the other camp. I think I'll put this one on the list for the next visit in which I'm able to participate.
Husband 60yrs., no symptms: PSA 10/04 2.73, 12/06 3.64, 5/09 3.9, 10/09 4.6, 1/10 5.0w/ free PSA 24
6 core biop 4/1/10 path rept: rt mid: adnocarc. G=3+3, 5% of core; R apx v. susp. minute ca, R base bnign w/ mod. atrophy, L side atrphy only; 2nd opnion JH confrmd
MRI - 15mm nodule
BiLatRP surg 7/6/10, path: T2c, nodes, sem.ves, extra caps. neg., adenoc both sides G=3+3 cntinent, Viagr-8/27 ED

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 12/1/2010 11:25 AM (GMT -6)   
Tony has it right.. It's catch as catch can..But removing nodes can lead to serious complications.. Removing lymph nodes can lead to leakage and fluid accumulation in your lower abdomen which can become infected.. Pull up the thread "Fairwinds decent into purgatory" ....Removing lymph nodes can be very tricky business...
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT, Dec

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 12/1/2010 12:30 PM (GMT -6)   
How much truth can you handle????  I would guess you believe PCa is a precise science, you will find out it is far from that, wonder if the doc will be that honest to tell you???  It is a random and flip of the coin science and I met a doc whom usually doesn't sample nodes, why bother it is all about selling the whole gig for some of them.  Some patients get surgery whom never were reasonable candidates for successful surgery, but were reasonable cash cows for less scrupulous docs.  How harsh of me?  I got two opinions from surgeons and luckily one was most honest in saying no way in my case as it would be for nothing (the honest doc is the first LRRP guy in the USA....I can see why he was chosen).  Iam glad I got 8 opinions in total to sort out the b.s. from reality and it back alot clearer then.  It was amazing the sales pitches I heard amongest all these docs.  My case was far from typical stats.  Best to you in your search for truth in disclosures on PCa.

Post Edited (zufus) : 12/1/2010 10:40:23 AM (GMT-7)


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 12/1/2010 2:34 PM (GMT -6)   
The surgeon I had was the honest one that Zufus was talking about.
 
He took out 3 nodes. I never asked him for any rationale.
 
Mel
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