Was diagnosed 8 months ago with 3 positive from the biopsy in the prostate , and one lymph node detected on pet scan. I accepted to join Proteus trial which is checking the efficiency of erleada as neo adjuvant ADT with lupron for 6 months before RP and then another 6 months of erleada and lupron after. I just got the RP and I was told before that I would also have an extended lymph mode removal.After the surgery I did a scan and with a big surprise I found out that the only lymph node that showed on the initial pet scan was still inside me even though because of neo adjuvant treatment he has shrunk a lot (from 26x20mm to 15x10mm).would it be possible that the surgeon missed it or he left it on purpose since he had shrunk so much? In case he missed it , is it still an option to go for a second round of surgery to get it or should I go for Radiotherapy plus ADT to try to correct the problem.
Thanks for any help
Jean
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Johnko
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The surgeon usually cannot see during surgery if the lymph nodes he takes out are affected, he removes lymph nodes according to a standard template. It often happens that the node which showed up on the PET scan does not get removed during the pelvic lymph node disection. To avoid that there is radio-guided LND: pubmed.ncbi.nlm.nih.gov/290...
You can get SBRT radiation now to destroy this lymph node met. Or see Dr. Maurer in Hamburg
LNs are very hard to find, especially when they've been shrunk by hormone therapy. No worries, because it is better to remove them all with whole pelvic salvage radiation anyway, as was suggested by this study at Mayo. You will never get all the microscopic cancer out of your pelvic LNs with surgery anyway. It is a fool's errand to try.
Allen, are there side effects to the lymphatic system over the med to log term if you radiate all the pelvic nodes? Do they weaken your immune system and reduce circulating blood cells? I seem to be prone to illness much easier after my IMRT and brachy therapy and my blood cell counts are all below normal range. I also tested negative for measles antibodies even though I got the MMR shot again in 1995. I'm thinking about doing salvage radiation soon...currently trying to get into a PSMA PET in Feb and go from there. If I cant get the PSMA soon enough (while I'm on a Lupron break) then I'll do the local Axumin scan.
Good info, interesting. I did read the study results you shared yesterday and noted that the part about SBRT vs ENRT and whether it's targeted to one location or the entire pelvic LNs.
Is it better to get this type of radiation on a lupron break when the scans can id the cancer locations or to get the scans then go on lupron for 1-2 months before zapping the cancer locations?
I just read the link about radiation improves immunity but in the article it seems to focus on mCRPC with short projected life span. I'm still ADT sensitive and haven't taken anything other than Lupron so far. Thus, I'm wondering if it's too early for me to try this pelvic radiation. About 1 in 5 thought salvage SBRT was appropriate.
according to the other article it said that 2/3 of both ROs and Uros and agreed that salvage after RT was not as effective as salvage after RP.
I had imrt&brachy as inital treatment so this makes it seem like doctors aren't too supportive of more radiation. I also wonder if the cancer spread due to being radiation resistant, which nobody really knows.
Salvage therapies after RT failure
RO
Uro
RP
56%
66%
LDR brachytherapy
34%
6%
HDR brachytherapy
42%
10%
SBRT
20%
5%
Cryoablation
40%
69%
HIFU
21%
13%
However, 2/3 of both ROs and Uros and agreed that salvage after RT was not as effective as salvage after RP.
I'm sorry I created confusion by showing you that survey. The only purpose is to show how uninformed Uros usually are about RO issues. Salvage after RT is usually more effective than salvage after RP.
But with brachy boost therapy, it's unlikely that you have a local recurrence. If your recurrence is pelvic LN-only and your pelvic LNs haven't been treated, that is still a possibility.
Another question then. Should I leave the trial and go for adjuvant radiotherapy or should I wait 6 months, monitor my psa and then go for salvage RT when needed?
If you are getting Erleada for 6 months, that may increase the effectiveness of the whole pelvic radiation to follow. But I wouldn't wait for PSA to increase - you know you have cancer in your LN area, and the sooner you stop it, the higher your chance for a cure. Remember PSA is not cancer - it is only a biomarker.
Thanks for your help. I actually don’t know if I am getting Erleada.Since I am in this phase 3 Proteus trial, if I am in the study group, I get Erleada+Eligard injection for another 6 months or I get only Eligard if I am in the placebo group. At the end of the trial I will get a PSMA scan. If Eligard alone is not enough to increase the effectiveness of radiation, I can consider leaving the trial anytime and go for radiation sooner.
There are studies showing that 2 months of ADT is as good as 6 months, so you might as well stick with the trial until then:. The extra time may be a benefit by giving more time for healing of incontinence. It's a bonus if you are getting Erleada.
I have an appointment with radiation oncologist later in February. He is one of the guy who is involved in the trial you mentioned regarding whole pelvic radiation and IADT. By the way I am getting a first PSA test next week. It will be 1 month after surgery and 6 months after beginning of clininical trial. What would be a good result? Thanks
It is too soon. Surgery disrupts prostate cells and puts a lot of PSA into the serum. That's why one waits 3 months. They are just looking for understanding for the clinical trial - you can safely ignore the PSA result - it's for them, not for you.
Good eveningSince you’ve been so helpful, I wanted to give you an update on my post prostatectomy results. For other readers, I just want to remind that I was on the Proteus trial which test the apalutamide as neo adjuvant treatment for locally advanced cancer. I did the surgery one month ago. The results are astonishing. My PSA shows below0,006 and all the results of what was removed have come free of cancer. It shows clearly that I was in the apalutamide arm and not the placebo.
I am still finishing the trial which includes another 6 months of erleada plus Eligard. Regarding the lymph node that was left behind the surgeon told me that it was very had to get and that with this post op psa it would be very surprising if there were any cancer left inside. We’re going to monitor it with pas rise and scan and if necessary we would radiate it.
Important for you as many authorities feel, because the seminal vesicles are so vascular, this is one of the major ways Prostate Cancer can spread to areas outside of the pelvis.
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I am 62, I live in France and I am treated at the CHU of Rennes.I was diagnosed in may 2020 with Gleason 8, psa 21 and one positive lymph node positive on CT scan. I have been advised by my urologist to join a clinical trial called proteus. The purpose of this trial is to check the potency of erleada as a neo adjuvant ADT before RT with EPLND and continue 6 months after. I got RP last month. I am planning to see a radio therapist next month to check my options
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