PLND for metasteses...not successful?

[bean1008]

A few days ago I got my first post-surgery PSA since my March 12th, 2020 pelvic lymph node dissection (PLND) surgery. To briefly recap...two spots on lymph nodes, one on each side of the pelvis, were detected in a gallium68 scan last December. I opted for a surgical extraction over other methodology. Path report showed four of the over two dozen nodes removed tested positive.

My last PSA of .46 was on January 2nd of this year and my first post-surgery test has come back at a .63

Of course I’m disappointed as I’d hoped for a dramatic drop as seen by others that went through the same procedure. I don’t have an in-person appt until mid June to discuss with the doctor. I know it’s a stretch but does anyone have any experience with something similar?

Thanks gang...best wishes to all!

[Tall_Allen]

I am not a big fan of PLND. I think that where there is one lymph node you can detect, there are many more that are too small to be detected by any means. You may be able to still have salvage radiation, but I suspect that the risk of lymphocele/lymphedema increases with radiation over surgical cutting. Worth discussing with a good RO, though.

[bean1008 in reply to Tall_Allen]

Thanks TallAlan. Studies I’d read showed a good 80% drop in PSA after PLND so I was hopeful but it seems it wasn’t meant to be. Blasting the entire area sounds brutal since it’s apparently undetectable even with the g68 scan. I’ve read that radiation at this point will cause issues with the bladder and colon and might outweigh the benefit. So yep it looks like a MO or RO for me.

[Hawk56 in reply to bean1008]

I have two separate radiation treatments for PCa recurrence.

SRT, 39 IMRT, 70.2 Gya to prostate bed for BCR in March 2016.

25 IMRT, 45 Gya to PLNs when C11 Choline scan showed four lymph nodes involved.

Consider talking to RO, I have had no SEs from either round of radiation.

Kevin

[RonnyBaby]

It sounds like 'something got missed' during surgery.

I was 'node positive' at Dx and had radiation treatment to the entire 'pelvic region'.

That, combined with ADT, got me to undetectable for a significant period of time.

Post treatment, I'm on an ADT holiday - don't know how long that will last, but it was worth the interruption.

Hopefully, I can cycle for years .....

[bean1008 in reply to RonnyBaby]

Good luck to you, Ronny!