Lymnph nodes not biopsied

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reachout
Veteran Member


Date Joined May 2009
Total Posts : 725
   Posted 4/1/2011 8:34 AM (GMT -6)   
So, I was just thinking, my lymph nodes were not biopsied, and I wonder how common that is, and if that was a good idea. After the operation 18 months ago the surgeon told me that the prostate unattached easily from the nerves, and was not sticky, so he spared the nerves. The pathology showed 4+3 with no extracapsular extension, though it was less than 1 mm from the edge. My PSA has been undetectable, so far so good, and my surgeon had over 300 Da Vincis at the time, and a bunch of opens, but now I wonder if the lymph nodes should have been looked at.

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/1/2011 8:48 AM (GMT -6)   
mine were. I'm probably wrong, but I thought that was the norm.

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6945
   Posted 4/1/2011 8:54 AM (GMT -6)   
My surgeon said that "it depends" - he took 12 in my DaVinci. We've seen more and less or none from a lot of those who have posted their pathology.

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5815
   Posted 4/1/2011 8:59 AM (GMT -6)   
It depends on the Surgeon, have a consult with him about it, express your concerns, as to why not. Be descerning to his response and ask moe if neede. I really don't know how many do, The majority, probably. Big point coming ! Just because yours did,t does not mean it has spread. Just because some or a lot do does not mean that it hasn't spread. Nomagrams do not take them into consideration, what do your nomagrams say. what little u have said about pathology appears to be a good sign it hasn't. Pca can really feed anxiety, don't let it, research, hope , pray, be positive and live your life , thats what any of us due pca or not. Good luck
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2842
   Posted 4/1/2011 9:14 AM (GMT -6)   
- it used to be the "norm" that the lymph nodes were checked first
- if there was a sign of cancer the procedure would be stopped.
- since radiation would be a better course of action with less side effects if the cancer had already escaped the prostate.
-but since joining HW, it appears it is that is not the case anymore - it is up to the doctor and the hospital to decide what to procedures to follow

-when in doubt , contact the surgeon and find out - remember, there is no such thing as a dumb question - only the question that is not asked.

hugs,
BRONSON
Age:55 -gay with spouse of 14 years, Steve -Peterborough, Ontario, Canada
PSA:10/06/09 3.86
Biopsy:10/16/09- 6 of 12 cancerous samples, Gleason 7 (4+3)
Radical Prostatectomy:11/18/09
Pathology:pT3a -Gleason 7 -extraprostatic extension -perineural invasion -prostate weight -34.1 gm
PSA:04/08/10 -0.05 -Zero Club
PSA:09/23/10 -0.05 -Zero Club
PSA:03/24/11 -0.02 -Zero Club
PSA:03/24/12- TBA

tigre
Regular Member


Date Joined Sep 2010
Total Posts : 69
   Posted 4/1/2011 4:28 PM (GMT -6)   
my surgeon also said it depends and that he saw no reason to take any nodes during surgery. my brother had some removed as his dr. said they were suspicious. he has been perfect since rp, except for ed of course. me not so fortunate. i had to endure the 39 rt treatments following rp but alls good so far now.

cupcake25
Regular Member


Date Joined Jan 2011
Total Posts : 24
   Posted 4/1/2011 4:50 PM (GMT -6)   
Before my husband's divinci surgery his doctor said he was going to biopsy his lymph nodes. After surgery he told me that he did not biopsy the lymph nodes. I guess when they get in there they can tell if they need to biopsy or not. His margins were clear.

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/1/2011 5:14 PM (GMT -6)   
they can get a very good idea, but they can't tell. My surgeon told me the day of surgery that everything looked good but that we would all have to wait that long week for confirmation. When i kind of pressed him he said "so far so good"

DaSlink
Veteran Member


Date Joined Feb 2011
Total Posts : 713
   Posted 4/1/2011 5:35 PM (GMT -6)   
For me they took 18 and biopsied 18. All negative.
Every minute you fish or ride,adds an hour to your life!

Age 52 Dx age 53 daVinci surgery
prostate volume 32 grams
Biopsy 12 cores with 7 positive
Gleason score of 7
1st PSA 38.7 10/05/2010
2nd PSA 49.9 11/23/2010
CT neg.
BS Negative
RRP on 01/25/2011
PT3a -40% involved
margin involved-Left anterior
lymph nodes -clear
1st post op PSA-0.26-03/16/11

reachout
Veteran Member


Date Joined May 2009
Total Posts : 725
   Posted 4/1/2011 6:02 PM (GMT -6)   
Thanks to everyone for your replies. At this point I guess I just have to trust the surgeon's judgment and the PSAs. I have another one coming up this week. I can't believe I'm letting the anxiety come back, I though I was past that.
Age: 66
Pre-surgery PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Post-surgery PSA one year of zeros.
Continent right away.
Viagra and other pills only gave me headache
Trimix working great!

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3738
   Posted 4/1/2011 9:22 PM (GMT -6)   
I'm not sure about this, but taking nodes to biopsy can increase the risk of complications involved with surgery..Sometimes abdominal drains must be put in place to drain the disturbed lymphatic system..A condition called "Lymphocete", something like that, can result and a fluid filled pocket or abscess can form requiring further treatment..Sealing off the cut lymph ducts is tricky..I speak from first hand experience..But in high-risk patients, they usually do it as the information gained is deemed worth the risk..
Age 68.
PSA age 55: 3.5, DRE normal.
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 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5815
   Posted 4/2/2011 9:48 AM (GMT -6)   
True dat, I had pratt drain for for 3 weeks after surgery plus 2 golfball size cells 2 mos after which self resolved after a month.
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 4/2/2011 11:09 AM (GMT -6)   
It's interesting that some surgeons do not dissect at least some lymph nodes. I can understand in G6 cases where active surveillance was also an option. But in intermediate and above risk cases there is very clear evidence that removing lymph nodes can be very helpful. Dr. Stan Brosman summarized it is his essay on the AUA2010 meetings in San Francisco. Guys like me had a a 100% improvement in biochemical failure and in prostate cancer specific mortality when the study period was extended to 18.4 years...

I just wonder how many doctors stay up to date with that stuff...

Tony
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:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2458
   Posted 4/2/2011 2:47 PM (GMT -6)   
My doctor didn't sample any lymph nodes, when I asked him why he didn't he told me that they looked "smooth" and the chances of having the cancer spread to them was less than 5%. To this day I wish he did. SO far I'm happy that 2 years after RRP I'm still undetectable.

proscapt
Veteran Member


Date Joined Aug 2010
Total Posts : 644
   Posted 4/2/2011 3:21 PM (GMT -6)   
Some of the clinical guidelines use a nomogram to assess the probability of spread to the lymph nodes and if the probability is less than 2% (or 1% for some physicians) they don't biopsy since there is some adverse side effects in some cases of removing lymph nodes. This is more rigorous than simply going by a hunch or by the feel of things intra-operatively.

You can go do the sloan kettering nomograms to check on the odds for your particular case after inputting your gleason, biopsy results, and other info.

Or you can google on CAPRA score; if your score is 1, 2 or 3 out of a possible 10 then your odds of lymph node spread is less than 2.5% and many docs would say no need to remove and dissect LN's.

That said, some docs think LN's should always be examined, regardless of the odds. Walsh seems to be in this group.

If you were EPE-, SM- SV- with nondedetectable PSA for 18 months, I'd say the doc made the right decision and the possibility of LN+ would have been extremely low under these conditions. But that's just my guess; check the nomograms and see.
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