Do lymph nodes simply act as a temporary filter to prevent cancer from spreading too far?
I was curious about this because I have 4th stage prostate cancer, and my Lymph had swelled to the size of a golfball.
When I took the ADT, my PSA went from 1000, down to 6, and all evidence of cancer disappeared from my lymph, pretty much immediately.
If this is the case, that the lymph is an important filter, it seems like there may be a lot of unnecessary removal, and radiation treatment occurring when cancer is detected in the lymph.
Would love to hear if anyone has more knowledge on this subject.
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Aldo62
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LNs do filter toxins. Because they may trap cancer cells, they may slow metastatic spread if confined to pelvic lymph nodes. The hope is to eliminate all cancer cells. While either radiation or PLND may remove cancer that is growing in the LNs, I think radiation stands a better chance of getting more of them. There's never been a comparative trial.
Some swelling in my groin at the lymph nodes was the reason I originally got tested. Turns out that I had a psa of 1000 and got immediate ADT etc treatment. But neither my standard doctor - nor my oncologist recognised the swelling as a sign of lymph nodes blocked by cancer. (they thought it was a hernia) The swelling disappeared rapidly on start of treatment. Through much reading I have learned that the lymph system is the bodys drainage system through which all sorts of dead cell and cancer materials pass. Not surprising then that some cancer cells get "stuck" there and develop. The lymph system has no pump - and relies on body movement to maintain drainage (could this be why excercise is so important??) What amazes me is how readily they cut out the lymph nodes - I think these are essential to the body
When lymph nodes become cancerous, they no longer fulfill their function, and only serve to spread the cancer. As far as we know, it doesn't help to remove them when the cancer is systemic in multiple areas anyway. While there is some hope that getting rid of cancer in the pelvic lymph nodes may halt further spread, you had cancer in a lymph node outside of the pelvic drainage area.
But I agree with you that removing healthy lymph nodes, as is done when surgeons do extended pelvic lymph node dissection (ePLND) may result in lymphoceles and lymphedema. That's why I only advocate pelvic radiation, which kills only the cancer but leaves healthy lymph nodes intact.
The thing is, my lymph nodes became huge and could be said to be 'cancerous', but it then immediately disappeared after ADT. Doesn't that mean that the loss of function would be just a temporary problem?
Then I think that - like me the HUGE nodes were lymphodema caused by the cancer blocking the lymph nodes and not the cancer itself. The lymphodema will magically dissappear as soon as the drainage path opened up.
new to commenting here- so finding my way. My salvage ePLND, done six years ago, has had no negative side effects. Yep, healthy ones were removed too, but so was a lot of cancer at usPSA of 0.10. After the nano-MRI (which I see you have written of - well done!) lite up five nodes, all US clinics recommend ADT and chemo. Full pelvic RT was out due to likely damage to organs given proximity of identified nodes, and I had already had salvage RT to prostate bed. Research led me to several studies which led to my decision for ePLND. This 2011 paper is one of them- europeanurology.com/article...
There has never been a randomized trial comparing ePLND to whole-pelvic radiation, and I see why ePLND may have been a good choice for you, given your previous RT. But the risk of lymphocele and lymphedema are higher with ePLND.
There has been a randomized trial comparing limited PLND to ePLND. It found no difference.
That leads me to believe that ePLND is often incomplete.
In Europe, where ePLND is more popular, they are experimenting with intra-operative PLN-detection techniques using PSMA. Perhaps that will increase completeness.
Meanwhile, I think whole pelvic radiation stands a better chance:
yet, how does one know if whole-pelvic radiation is complete? And I know men with side effects from this very procedure - as we know all treatments have risks. The randomized trial you referenced is incomplete and inadequate - but then I question most compartitive trials - so often they are biased. Sadly, reliable unbiased data is insufficient across the spectrum. The LND method I chose began with removal and surgical beside biopsy of common iliac nodes. If cancer is found then the reach is extensive. If no cancer found then fall back to prostate bed/gland. Note the group I selected only does LND when warranted by imaging. My intent was immediate removal of tumor burdens and more accurate and near immediate evaluation by usPSA. And of course there is the discussion - if the cancer is out can it all be removed/killed? And then, how does one truly prove a cure? Note, a friend of mine and a personal advisor was Dr John Wickham, author, recognized 'godfather' of keyhole (robotic) surgery who strongly cautioned against lymph node chasing. John passed a few years ago.
Whole pelvic radiation treats EVERYTHING in the area, while ePLND removes only those LNs that the surgeon can find. While lymphocele and lymphedema can occur after radiation, incidence is much rarer.
IDK why you imagine that the clinical trial was "incomplete or inadequate" or "biased." Putting one's imagination ahead of a clinical trial performed by the top researchers at MSKCC, and published in European Urology (the most prestigious urology journal) is just plain silly IMO. Andrew Vickers is probably the most prestigious statistician there is. I would think twice about questioning anything where he is the lead author (and I have 20 years of statistic experience).
With the annual death rate from this disease increasing, with millions on ADT, with national screening guidelines that emphasizes fear mongering over early detection, and as a patient facing metastatic disease, yes, I question many things based on my own experiences, studies and consultations with doctors in several countries.
I appreciate you have a prominent if not dominate voice here, but as your own bio states, you are “not a physician”. How fortunate for you that you are cured by a single localized, perhaps focal treatment. IDK why you think it is okay to berate other patients that not only face a more threatening cancer than your own, but who have experienced and benefited from investigative techniques and treatment methods that you have no experience nor formal training with.
We better work together. We are all connected by a sometimes deadly, sometimes chronic disease and we all suffer from treatments with more or less side effects. Let’s keep this in mind.
It has nothing to do with me, and your ad hominem attack is childish. Without cause and only based on your imagination, you question a trial by arguably the most prestigious researchers publishing in the most prestigious journal. There is always room for questioning, but you did not pose any valid objections. You emotionally jumped to an unfounded conclusion that that the clinical trial was "incomplete or inadequate" or "biased."
I wrote, "I see why ePLND may have been a good choice for you, given your previous RT." But, IMO, your route is something I would question for the OP, who is in a different circumstance.
If nothing else our little chat exemplifies the disparities we face with this disease.
It is dumfounding you think it is okay to judge, to write, "I see why ePLND may have been a good choice for you, given your previous RT" ; and then only offering up “may”.
After medical consultations on two continents reviewing the nanoMRI findings from Radboud UMC and other pertinent medical records, the clear decision was ePLND over extended pelvic region radiotherapy inclusive of the para-aortic areas. I appreciate you do not have my medial records and that you are not a doctor. Respectively, perhaps you might consider limiting the public display of your medical opinions, at least on my diagnostic and treatment procedures. (As I am not inclined to comment further on this discussion, I anticipate this will be my last reply).
LOL. It won't happen. I am well aware of Jelle Berentz and the great work he has done on Combidex/MRI for detection of lymph node metastases. Unlike you, I don't pretend to know things I can't know. Epistemic humility is what all scientists are trained in. If you have a crystal ball that tells you what would have happened had you taken a different path, that is not scientific, but is certainly within your right to believe it is true.
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