Lymph node treatment

[Spaceman210]

Since lymph nodes can be removed surgically during first-line treatment, why is there not common use of subsequent surgery to remove affected nodes in the region to at least reduce the metaststic burden more certainly than just radiating them (not to eliminate adjuvant ADT or radiation?) I have seen study references to such surgery being used in Europe but not much in the US.

Jeff

[joeguy]

5 of my nodes were removed during robotic RP..... 2 of them had tumors. Im guessing he got the ones that looked suspicious, but if there were 2, Im sure there are others. Problem is they cant be seen on scans yet (haven't splurged for the ultra sensitive PSMA scan or Axium scan yet). Apparently PC is hard to see with even PET scans until it gets to several millimeters in size

[Ran2599dy in reply to joeguy]

Major side effect of messing with the lymph system is lymphedema. I got it after radiation and my right leg still swells after five plus years.

[joeguy in reply to Ran2599dy]

luckily I haven't had lymphedema.....I did however leak lympatic fluid out of the incision they made on my side for a drain for about a week after surgery in 2016. I think they may have removed the drain tube a bit too soon.

[Bebby1 in reply to joeguy]

Thanks for replying

We are in Australia

It was never suggested, not have I heard of any removal of nodes

MYbe because the PET scan indicated heavy involvement... where would they start

I go to this site at least twice per day

I see treatments mentioned that are not available here???

As always, I wish everybody the best on their journey through this crap disease

[joeguy in reply to Bebby1]

Always wanted to visit Australia...... I live in a rural area in Oklahoma. Im sure I would be right at home in the bush

[Bebby1 in reply to joeguy]

Actually We do live in the bush

On a 1200 acre sheep and wheat farm

All our specialists are two hours away

But the silence and the stars make my husband happy

And that’s a great thing

[Tall_Allen]

As joeguy said, it is not at all more certain that surgery is better at eliminating the cancerous pelvic lymph nodes than radiation. The reason that ePLND hasn't caught on in the US is the lack of evidence that it accomplishes anything, and the possible morbidity (lymphoceles and lymphedema). Some US surgeons do it - Karnes at Mayo has been a proponent.

[ctarleton]

One line of thought is increasing risk of various side effects. Lymphedema is one of them. Not pretty nor easy to live with day after day after day after day....

[paulparry]

Be careful what you ask for!

Messing with lymph nodes is a tricky situation and I would limit it to major cases and highly visible tumours. Side effects could be more devastating.

Chemo & Radiotherapy has kept mine under control so far but I think the lymph nodes are a major transport mechanism of PCa. Unfortunately its usually too small to see.

Lets hope for improvements in immunotherapy soon.

[Bebby1]

There are so many lymph nodes in the human body

All that feed each other and of course drain whatever

Lymphedema was my husbands first symptom

However despite the PET scan indicating that even the salivary glands are affected since having 2x doses of docetaxal coupled with hormone that stops testosterone feeding them his legs and groin area has returned to normal

[mintlatte in reply to Bebby1]

That is very much like my husbands... it was the lymphedema that alerted us something was wrong. He also did 12 taxotere and is on Lupron. Thankfully only one minor issue with swelling in his right leg and we seem to have that better now too. It had gotten so heavy in his lymph system that based on a PET scan before a biopsy they thought it was wide spread lymphoma. I did some reading on surgery and it seems that it just isn’t proven to reduce eventual hormone resistance or cure it. Given what lymphedema in my husbands case was like I would rather not risk it.

[Break60]

I thought it was SOP to examine and dissect cancerous LNs during RP. I had ten removed , all benign during open RP. So I guess it’s not easy to see if they are cancerous.

[Ralph1966]

During my RARP surgery 63 lymph nodes removed, because I had G score 4+5, and now after 15 months my PSA increased from 0.03 to 0.05 and will repeat in 3 weeks + PET scan with most likely Radiation and hormonal therapy per the MO.

The ultra sensitive PSA was 0.008 for 13 months then 0.020 increased to 0.030 four weeks after the last one.

[j-o-h-n]

I guess by now you're spaced out.

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 03/01/2019 7:49 PM EST

[RonnyBaby]

I got my 'node positive' radiation treatment about 2 years ago. They found a couple of hot spots and did their thing.

Today my PSA is undetectable (for nearly a year now) and further testing (advanced oncological blood work) shows that the 'advanced, aggressive' Dx is taking a time out.

My testosterone is starting to climb (slowly) after I stopped ADT - I'm above castration range.

Now we watch and wait ....