Is it a standard practice to have your pelvic lymph nodes radiated during the IMRT of your prostate?

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akai
Regular Member


Date Joined May 2012
Total Posts : 245
   Posted 9/13/2017 9:09 AM (GMT -7)   
Wonder if any high risk (G9) had IMRT treatment without radiating the lymph nodes at the same time?


Is it pretty standard now to treat the pelvic lymph nodes while having IMRT for high risk patients?

Thanks.

Akai

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8817
   Posted 9/13/2017 9:47 AM (GMT -7)   
There is no standard. It's only done when indicated. There is usually some suggestion, radiological or nomogram based, to add the extra radiation. A GS9 has a significant probability of LN infiltration. Discuss it with your RO.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Redwing57
Veteran Member


Date Joined Apr 2013
Total Posts : 2292
   Posted 9/13/2017 11:35 AM (GMT -7)   
Interesting question, and I have no idea. Maybe one of the smart folks here will chime in. I'll relate my personal choice though.

Nomograms predicted almost a 40% chance of my lymph nodes being involved but undetectable, so we irradiated them. Dr. Mack Roach was one of the proponents of it that encouraged me to do this back in 2013.

If I recall correctly, the suggestion at the time was if the Roach formula suggested 15% or more likelihood of lymph node involvement that it was worth irradiating them. The Roach formula is:
[2/3 × PSA] + [Gleason score − 6] × 10. For me at diagnosis the formula yields: (2/3)*5.2 + (9-6)*10 = 33.5%, therefore zap the buggers. Did it help? Who knows...

I had no side effects from it.

Not sure if it's still recommended or not. This stuff goes back and forth a lot.
55@Dx 4/16/13
Bx: 6/12 pos, G9=5+4 (80%, 60%), 4+5 (2@100%, 80%, 10%), PNI+
cT3a (3T mpMRI: Bilateral EPE, NVB+, SV-, LN-)

Pre:
Date PSA fPSA
9/12 4.1 15%
3/13 5.2 12% PCA3=31

Tx:
IGRT by IMRT, 44 done 8/28/13: 50.4 Gy pelvic nodes, 79.2 Gy prostate
ADT2 3 yrs: Lupron/Casodex, ended 3/16

PSA <0.1 : 8/13 - 5/16;
steadying? - 0.2-8/16, 0.5-12/16, 0.7-3/17, 0.8-5/17, 0.8-7/17

InTheShop
Veteran Member


Date Joined Jan 2012
Total Posts : 7924
   Posted 9/13/2017 12:33 PM (GMT -7)   
No standard other than the RO assess that when planning the treatment. Each case is slightly different. Your milage may vary. Past performance isn't an indication of future performance.

Andrew
I'll be in the shop.
Age 57, 52 at DX
PSA:
4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13,
.7 5/14, .5 10/14, .5 4/15, .3 10/15, .3 4/16, .4 10/16, .4 5/17
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post

akai
Regular Member


Date Joined May 2012
Total Posts : 245
   Posted 9/13/2017 2:52 PM (GMT -7)   
Thanks all.
When I was still at G6 and consulted with Dr. Rossi at Scripps Proton, he suggested treating the LNs.
When I consulted with Dr. King for SBRT, I was G9 then, Dr. King suggested treating LNs.
Now I am doing IMRT (following HDRBT boost), my RO's plan includes treating LNs but leave it up to me if I do not want it he can rework the plan.

Redwing, my statistics are pretty much like yours, using your formula, it yields pretty much 33%. So, it looks like a go and hope for the best. I am still concerned about the SEs though.

Akai

Astronut
New Member


Date Joined Dec 2016
Total Posts : 16
   Posted 9/13/2017 3:33 PM (GMT -7)   
Can anyone comment on the potential additional side effects from pelvic lymph node radiation? I can't find much information specific to pelvic lymph node radiation. Is lymphedema the primary concern and how likely is that?

Kent M.
New Member


Date Joined Aug 2017
Total Posts : 10
   Posted 9/14/2017 9:01 AM (GMT -7)   
Quick question, are 'whole pelvic radiation' and 'pelvic lymph node radiation' the same thing?
Age 59, 58 at Dx
Pre PSA: 08/19/16 - 71.4, 10/03/16 - 87.3
Bx: 10/12/2016, T1C, G7(4+3), Vol. 31cc, left 3/6 pos., right 0/8 pos.
Bone scan: 11/16, no mets
Tx: 02/17 - 04/17, 44 IMRT, Whole Pelvis 45 Gy, Prostate Boost 34.2 Gy, total 79.2 Gy
ADT (6month Lupron): 11/16, 05/17
Post PSA: 08/17 <0.1

Post Edited (Kent M.) : 9/14/2017 10:34:25 AM (GMT-6)


Max Vision
Regular Member


Date Joined Apr 2012
Total Posts : 214
   Posted 9/14/2017 9:44 AM (GMT -7)   
My RO said the following, and my LN were not treated:

"Whether or not to treat the nodes is an area of controversy, with no definitive evidence that it is useful. Since it can add significant toxicities, it is only done when absolutely indicated (for example when imaging shows enlarged pelvic nodes)."
age now 67
8/13 Bx: 1/7 60% Left Apex, 1cc tumor, 43cc prostate, G6
9/14 mpMRI guided Bx 5 core, L apex 2x(3+3) 2x(3+4) 20%-30%
2/15 PSA 7.6
3/15 Artemis Bx 15 core 1x(4+5) 40%, 2x clean bone scans
4/15 start Lupron 9 mo, Casodex 4 mo
6/15 SBRT (@UCLA), PSA <0.1 T<20
4/16 PSA<0.1 T=40
7/16 PSA=0.04 T=300+
1/17 PSA=0.07 T=502
6/17 PSA=0.06 T=475

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8817
   Posted 9/14/2017 9:53 AM (GMT -7)   
Astronaut-

The primary concern is bowel/rectal toxicity. Lymphedema/lymphocele is a very minor concern with radiation - it is an important concern with surgical dissection.

Kent-

Whole pelvic radiation may include the prostate (if there hasn't already been a prostatectomy) and prostate bed. Pelvic lymph node radiation may exclude those areas, for example, if the prostate has previously been radiated.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

George_
Regular Member


Date Joined Apr 2016
Total Posts : 408
   Posted 9/14/2017 11:53 AM (GMT -7)   
akai said...
So, it looks like a go
Since you are a Gleason 9 it is very likely that there are affected lymphnodes which will cause a recurrence. So to fight the cancer have the lymph nodes radiated.

George

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3389
   Posted 9/14/2017 1:02 PM (GMT -7)   
All the docs I met said to radiate the nodes due to the risk level. We did so and I had zero adverse side effects.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 since February 2011

CaliJR
Veteran Member


Date Joined May 2015
Total Posts : 649
   Posted 9/15/2017 4:43 AM (GMT -7)   
Hi Akai, good question to the group. For a G9 patient it seems almost all of the ROs want to zap the lymph nodes. It seems most guys I talk to have no issues, or minor issues that resolve quickly after treatment ends. After getting advice to treat my lymph nodes by Dr King and other ROs I did so. For me I seem to be in the minority and have had to deal with Chronic Radiation Enteritis. Finished IMRT last May and still suffering. Can't say why I am the lucky one for that, but I did use a local RO instead of going to UCLA or other major institution. It is a tough call to go against the standard advice as a G9 wondering if you make that decision will it come back haunt you. Good luck on your IMRT. Take care. -JR
CaliJR
Age 53. Diagnosed 51. PSA 7.1-PSA Free=5% 9/15: PCa G9 (4+5)
18 Mnths Casodex & Lupron started Dec 2015
HDR Brachy@UCLA 2/29/16 & 3/1/16 Zometa I.V. 3/8, 9/7 & 4/3
IMRT: 28 Fractions Completed 5/5/2016
Taxotere Chemo Ended 8/7/16

Treatment Over 5-31-2017
SE: Chronic Radiation Enteritis, Dysuria
CP Forum: MP, DD
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