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mgl
Regular Member


Date Joined Feb 2007
Total Posts : 122
   Posted 2/14/2007 3:59 PM (GMT -6)   
During the da vinci surgery do they remove lymph nodes?

pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 2/14/2007 4:58 PM (GMT -6)   
i believe that the information below pertains to all kind of PC surgery. there should be no difference in that decision between open radical surgery and robotic surgery. it appears from the research below that the decision to remove the lymph nodes is made by the surgeon depending on his findings and the cancer stage of the patient. i believe it is the practice of many surgeons to test the lymph nodes and tissue in the margins for cancer during the surgery to determine if any removal is necessary.

I THINK IT IS EXTREMELY IMPORTANT THAT THIS ISSUE BE DISCUSSED WITH THE SURGEON PRIOR TO SURGERY AS TO WHETHER OR NOT HE WILL REMOVE THE LYMPH NODES AND HOW HE MAKES THIS DECISION. HE SHOULD HAVE A PATHOLOGIST TEST A SAMPLING OF THE LYMPH NODES WHILE THE SURGERY IS IN PROGRESS. IF ANY ARE CANCEROUS, HE WILL HAVE TO MAKE A DECISION AS TO WHETHER THEY SHOULD ALL BE REMOVED.

I HOPE THAT SOME OF THE MEMBERS HERE CAN TELL YOU WHAT THEIR SURGEONS DID AND WHY. TAMU's post below confirms what I believed (i.e., that a responsible surgeon will not chance leaving the lymph nodes in). to leave them in poses a risk for cancer recurring down the road if in fact the lymph nodes contain any cancer. there is at least one recurrent case of cancer after surgery on this website whereby they have detected cancer in the lymph nodes. when this happens it is a very sad situation which hopefully can be resolved if caught in time enough.

******comment by Sloan-Kettering one of the top cancer centers in the U.S. http://www.mskcc.org/mskcc/html/62034.cfm

To treat prostate cancer, surgeons generally remove the prostate, as well as some tissue surrounding it, and usually remove a sample of the lymph nodes in nearby tissue to determine whether the cancer has spread beyond the prostate. In general, 75 percent of men treated with surgery will never have a recurrence of their cancer.

*****comment by malecare, a good PC website. http://www.malecare.com/prostate-cancer_65.htm

Prostate cancer surgery also known as a radical prostatectomy, is a surgical procedure whereby the prostate gland and attached seminal vesicles are removed. Lymph nodes near the prostate are usually removed at the same time.

*****comment by the american cancer society. http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Surgery_36.asp

Some surgeons remove lymph nodes from around the prostate at the time of surgery.. If any of the nodes contain cancer cells, which means the cancer has spread, they often will not continue with the surgery because it is unlikely that the cancer can be cured. Other surgeons only remove the prostate gland and may not remove lymph nodes. The decision depends on your PSA level and Gleason score. If either is high, they might remove the lymph nodes around the prostate.

*****comment by the prostate cancer research institute (which incidentally is an excellent website for PC research and education). http://www.prostate-cancer.org/education/localdis/brosman_RP2003.html

we have found that less than three percent of men in the low to moderate risk categories had metastases in their pelvic lymph nodes. Many urologists are no longer removing these lymph nodes.

*****http://www.urologyhealth.org/adult/index.cfm?cat=04&topic=130

The pelvic lymph nodes, small oval or round bodies located along vessels that filter lymphatic fluid, are usually the first site of any spread of the cancer beyond the prostate gland. Normally, these lymph nodes are also removed during the operation. Fortunately, you have many other lymph nodes, so your body will not miss these few.

good luck!

Dave
68, Biopsy 9/27/06, Stage T1c, PSA 7.1, Gleason 6 [less than 5% in two areas], Gleason 7 (3+4) [less than 20% in third area], negative DRE, bone scan and MRI. Starting proton radiation therapy 2/22/07.

Post Edited (pcdave) : 2/14/2007 4:33:07 PM (GMT-7)


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 2/14/2007 5:15 PM (GMT -6)   
mgl,

My surgeon's protocol was to remove the lymph nodes. His reason is that if any cancer cells get out of the prostate there is a high probability that they will migrate to the lymph nodes. In his opinion sampling the lymph nodes to determine if there is any cancer there is similar to doing a biopsy on the prostate. Just because the biopsy may come back negative does not mean that there are not some cancer in the prostate that was just missed by the needle. In his opinion there is little to gain by taking the risk. He felt strongly enough about this that he will not do the surgery if the patient wants the lymph nodes sampled and analyzed.

Tamu
Diagnosed 7/6/06
1 of 10 core samples, 40%
Stage T1c, Gleason 3+3
Da Vinci on 11/01/06
Catheter out on 11/13/06
56 Years Old
Post Op Path
Gleason 3+3
Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06
No more pads as of 1/13/07


pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 2/14/2007 5:40 PM (GMT -6)   
tamu

you had a very competent surgeon! it is obvious that some recurrent cases of PC have resulted because of failure to remove all of the lymph nodes. when i posted my message above, i was surprised to find, in my test sampling above, that many surgeons don't fully remove the lymph nodes and rely on sampling or stage of cancer to make that decision.

dave
68, Biopsy 9/27/06, Stage T1c, PSA 7.1, Gleason 6 [less than 5% in two areas], Gleason 7 (3+4) [less than 20% in third area], negative DRE, bone scan and MRI. Starting proton radiation therapy 2/22/07.


myman
Veteran Member


Date Joined Feb 2007
Total Posts : 1219
   Posted 2/14/2007 6:06 PM (GMT -6)   

mgl - listen to pcdave and tamu.  Myman and I are gathering information from pcdave and others to see what can be done about lymph nodes that were NOT removed and are now cancerous.  You do not want to be in this position.

All the best to you


Husband Diagnosed 11/17/05  Age: 63  No Symptoms
PSA: 7.96, Positive DRE
Biopsy Right: 6 of 6 Cores Positive  Biopsy Left: 1 of 6 Cores Positive
Gleason: 4+3 = 7  Stage: T2B N0 MX
2/09/06: LRP  Restage: T3A NX MX 
3 mo. PSA Post Surgery:  11.8, 12.9, 13.9  Bone scan, CT scan, Endorectal MRI, Chest XR - neg.
9/06/06: 6 mo. PSA:  18.8  CT shows lymph node involvement  Start HT Lupron 3 mo. shots
11/08/06: PSA  0.8
 
 
 


kw
Veteran Member


Date Joined Nov 2006
Total Posts : 883
   Posted 2/14/2007 9:31 PM (GMT -6)   
    Mine were removed during my surgery.  Lab's were clear!

    43
    PSA 5.7 - Discovered during Annual Physical with Family Practice Dr.
    Gleason 7
    Biopsy - 3 of 12 positive (up to 75%) all on left side of prostate
    RRP on Oct. 17, 2006 - Nerves on right side saved.
    All Lab's clear.  No Cancer outside prostate
    Cathiter in for 3 weeks due to complications in healing. Removed Nov. 9, 2006
    First Post op PSA on Dec. 11, 2006  Undetectable 0.00
    Office visit on Jan. 19th due to continued excessive urine leakage.
    Scheduled Feb.20th Cystoscope with possible Cottigen injection into bladder neck to help control leaking.
   


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 2/15/2007 12:33 AM (GMT -6)   
Hi ~ mgl,

We requested they be removed and we also went to the extreme of removing nerve bundles.
A very personal choice but one we would make all over again.

:) Lee & Buddy

mama bluebird - Lee & Buddy… from North Carolina

Link to our personal journey…>>>     Our Journey ~ Sharing is Caring 

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy with "wide excision"

PSA 4.6   Gleason  3+3=6    T2a   Confined to Prostate

2nd PSA 02-06-2007 Less than 0.1 Non-Detectable :)

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