para-aortic lymph node

[6357axbz]

Anyone here had para-aortic lymph node involvement?

[Tall_Allen]

My friend did. He had it treated with SBRT and some local nodes, after having whole pelvic radiation. In his case, it had already spread out from there.

[ctarleton]

I had that involvement. Unfortunately, I also had advanced disease at original diagnosis with involvement in several other enlarged lymph nodes in my abdomen and chest, as well as numerous bone mets from the pelvis upward. I went straight to treatment(s) for widespread systemic disease.

You may have already seen Chapters 7 and 8 of the NCCN Guidelines for Patients - Prostate Cancer, as a background for up-coming discussions of typical standard of care options that might be offered by your doctor(s). You can look into some of those options for familiarization purposes ahead of time, if you wish.

nccn.org/patients/guideline...

If you may just have the one area showing up on something like a PSMA PET scan, maybe you will be able to try some radiation "whack-a-mole" on it.

Good Luck!

Charles

[6357axbz in reply to ctarleton]

Thanks Charles

[Irun]

I was diagnosed T4n1m1a just over 5 years ago G9

Spread to one lymph in pelvis and other in para-aortic lymph which had grown to 3cm . Early chemo and radiotherapy to prostate (not lymph’s) . 6 months later PSA started rising again . Was 342 down to 0.5 then up to 4 quite quickly . Started abiraterone 4 years ago plus increased exercise , Chinese medicine, a few supplements and mainly (but not always ) vegan and u processed food .

PSA now 0.13 mri scan 2 months ago had lymph on aorta not showing at all and pelvis one down to normal size .

Can’t tell you exactly why . I have run every day for the last 168 days and do core stuff 4 days a week .

[timotur in reply to Irun]

Irun: Congrats on your results and also for running 168d straight... ! As a fellow runner I know how hard that is to do. On Lupron, I need to take a day off between runs due to joint pain. Keep up the good work!

[Hawk56]

Yes

Here's the results of C11 Choline scan in Jan 17:

Enlarged, mildly choline avid left external iliac chain

lymph node (axial image 238), measuring 1.1 cm. 0.5 cm, mildly choline avid left para-aortic lymph node (axial image 184).  Faint choline

activity within a lower left para-aortic lymph node (axial image 189).

All of these are suspicious for nodal metastases. Prominent lymph node

at the junction of the right external iliac/inguinal lymph node chains

demonstrates mild choline uptake (axial image 249). This could be

reactive/physiologic or metastatic.

Heterogeneous activity within a few thoracolumbar vertebral bodies

should be artifactual secondary to bed position. No additional foci of

abnormal osseous choline uptake. No abnormal choline uptake in the

prostate bed.

Significant incidental findings on the unenhanced, attenuation corrected CT: Scattered aortoiliac atherosclerotic calcifications. Bibasilar atelectasis. Colonic diverticulosis. Degenerative changes of the spine.

I had surgery in Mar 14, T2CNoMX, ECE, SV and margins negative. BCR after 18 months, SRT in Mar 16. That failed.

Given the PLNs showed in C11 Choline scan, GS 8, time to BCR, PSADT and PSAV we elected to do 18 months of ADT, six cycles of taxotere and 25 IMRT to the PLNs. WIth the scan my radiologist built wider margins and higher boosts to those PLNs identified in the scan.

Last treatment was May 18, PSA undetectable since. T in Feb 19 was 482.

I see my urologist every 3-4 months for labs and consult.

I know I am not "cured" but have enjoyed time off treatment.

I was fortunate, no bone or organ involvement.

Kevin

[MateoBeach in reply to Hawk56]

Two years undetectable off of ADT with full T recovery. Great results Kevin! Congratulations. Just maybe cured?

[Hawk56 in reply to MateoBeach]

The general consensus is advanced PCa is not curable, though with the advances in treatments, newer drugs, improved radiation, other treatments such as HIFU as the emerging precision treatments, combined regimens and bringing treatments forward in the disease, that paradigm may be be changing.

What Kwon said intrigued me, why do linear and sequential treatments with single therapy, each destined to fail, why not combine treatments and bring them forward in the disease to overwhelm it when it is in perhaps a state that is more affective to the combined regimen.

Things have changed greatly since 2014 and I expect the same over the next 3-5 years. I have changed my thinking to reflect that, will this work for the next 3-5 years, if so, great, there will new options then.

Think AIDS and perhaps diabetes, once fatal for many, now “chronic” diseases.

[cigafred]

I had a eight para-aortic and common iliac nodes detected, max 9 mm, IMRT and 4-mths ADT did little once the ADT wore off. PSA resumed its rise.

[MateoBeach]

Yes I had two para-aoritic nodes on left side of pelvis on Ga-PSMA scan last August and nothing anywhere else. Treated with IMRT to left hemisphere-pelvis with boost to the two modes. With 4-6 months of ADT.

SBRT alone to PLNs has a high rate of failure due to recurrence at other untreated sites.

My PSA dropped by half and trending down (now 0.128). So a re-scan with DCFPyL last week (6 months post treatment) shows one of the nodes remaining a bit smaller and with weak PSMA activity. I am hopeful that it is still in the process of slowly dying from the radiation. Of course much uncertainty remains.