Prostate Cancer Metastasis to Retroperitoneal Lymph Nodes

[dac500]

I am just curious to know is there anyone with prostate cancer spreading to retroperitoneal lymph nodes. Why it is not very common for prostate cancer to spread to retroperitoneal lymph nodes?

[Tall_Allen]

It is common. It's just that it is usually found in pelvic lymph nodes first.

[dac500 in reply to Tall_Allen]

I read some articles that said it is uncommon. For example:

ncbi.nlm.nih.gov/pmc/articl...

[Tall_Allen in reply to dac500]

That case was in a man originally diagnosed with retroperitoneal and renal metastases - that is uncommon. It is common for lymph node invasion to start in the pelvic lymph nodes and spread from there.

[GP24]

This study reports where mets recur after treating the lymph node mets in the pelvis. Retroperitoneal lymph nodes are mentioned.

ncbi.nlm.nih.gov/pubmed/271...

[tango65]

It is not infrequent. I had many (more than 5) retroperitoneal nodal metastases, 3 1/2 years ago . I also had 3 pelvic nodal metastases. I went to Germany in 2016 and got them treated with Lu 177 PSMA. One treatment was enough. Last Ga 68 PSMA did not show any metastasis. PSA is increasing reaching 0.7. I will get another Ga 68 PSMA next month.

[StayingOptimistic in reply to tango65]

Hi tango65,

Where do you get the g68 psma? Do you pay for it or covered by insurance? If you pay, how much?

Thanks and happy new year.

[tango65 in reply to StayingOptimistic]

I am getting the Ga 68 PSMA PET/CTs done at UCLA. They charge $ 2800.

[ctarleton]

I might have had some at my original diagnosis, very advanced with around 25 bone mets and numerous lymph node mets and a PSA in the thousands. The most problematic lymph node for me, however, was one in a lower left iliac chain that had grown to about the size of a golf ball, and was VERY painful, along with a painful spinal met at L4-L5. Thankfully, both responded very well to initial systemic therapy with Lupron about 6 years ago.

Why is it not very common for prostate cancer to spread to retroperitoneal lymph nodes? I'm no doctor, but I'd guess that the retroperitoneal lymph nodes are not in the primary lymphatic drainage area for the lower pelvis where the prostate resides. Spreading cells would have to take a more circuitous route to travel there and establish. (Spreading through the blood system probably accounts for the more common tendency to spread along the spinal bones column, out to the ribs, or around the pelvic bones.)

[Dachshundlove]

My husband has a cancerous retroperitoneal lymph per psma pet scan. Not unusual.

[countrymusic101 in reply to Dachshundlove]

Same here with me.

[countrymusic101]

its Possible, it happened to me. PSMA pet scan lite up inside my prostate gland and 1 small retroperitoneal lymph node. Nothing lite up in my pelvic lymph nodes

[timotur]

In the pelvis, prostate adenocarcinoma may metastasize to various lymphatic chains:

- chains ofthe anterior pelvic route (anterior wall of the bladder, to theinternal iliac nodes);

- lateral route that drain to the medialchain of the external iliac nodal group;

- the internal iliac(hypogastric) route, which drains lymph to nodes located atthe junction between the internal and external iliac vessels;

- and the presacral route, which includes the lymphaticplexus anterior to the sacrum and coccyx and extendingupward to the common iliac nodes.

researchgate.net/publicatio...

Mets above the common iliac artery bifurcation such as to the retro-peritoneal LN’s characterize a patient as M1, below that line, N1.

[GAdrummer in reply to timotur]

Thanks for the info. My husband was diagnosed by a urologist as N1 with retro-peritoneal gland that he biopsied. I thought it was M1. I had to educate the urologist. I think the reason for this location of metastasis was the removal of pelvic lymph nodes at the time of surgery for leiomyocarcinoma on his leg two years previous. The urologist is amazed to find my husband 10 years later still in his office for those Lupron shots. Luckily we found a young medical oncologist that found the key treatment to finally bring his PSA down to undetectable for the first time this fall. Keytruda

[timotur in reply to GAdrummer]

You were correct in educating the Uro, a retro-peritonial LN is considered a distant met, thus M1. Reading your bio, you all have come a long way since the original dx. Congrats on the response to Keytruda.