Retroperitoneal Lymph Nodes

[JolleySprings]

Curious about the difference in Para Aortic Lymph nodes as opposed to Retroperitoneal lymph nodes in PC metastasis… other than their location in the body.

Thanks!

[103532]

Hi, My husband recently completed his radiation to this area. From my understanding, the para-aortic lymph nodes are in the retroperitoneal space. My husband had PSMA avid small retro-caval nodes, which were in the back of the abdomen near the ureter. It is an uncommon area, but we were told these small nodes are increasingly discovered thanks to the PSMA Pet scans. We are hoping the doublet ADT and the extended pelvic IMRT to incorporate this nodal chain will keep things at bay.

Stephanie

[JolleySprings in reply to 103532]

My husband has had at least 5 PSMA scans all showing NED…. With PSA continuing to rise they finally did a CT scan with contrast etc…. Just last week … they did an Auxium scan… and found MULTIPLE Nodes light up in the retroperitoneal abdominal area. He is at PSMA avid.

We see oncologist on Thursday. At this 7 yr point for us ADT has stopped working… nor did NUBEQA. Or Zytiga…. 😩😩😩😩😩😩

[103532 in reply to JolleySprings]

II am still learning and am no expert, but I am curious if you have asked about continuing ADT but adding a Parp inhibitor? That may be the next step When they dissected the para-aortic nodes, was the tissue still adenocarcinoma? The two questions I would ask the oncologist would be about the parp inhibitor and resensitizing the cancer to ADT (such as Lupron/ with dexamethasone instead of prednisone or Docetaxel chemo. Others are more knowledgeable than me. I also think there is hope and time on your side still because there is no organ or bone involvement yet.🙏 I am allways searching for patients who have a similar progression to my husband to see how they are doing. Please keep me posted!

Stephanie

[Ahk1 in reply to 103532]

Please keep us posted. Thanks

[JolleySprings in reply to 103532]

You are Sooo kind to respond and want to educate yourself and others with what you have learned in this journey!

My husband had RP 7 years ago. At the time his Foundation One report reported he has a CDK12 mutation. However ADT did work for a couple months f years. Then we went to Daraludimide (?) Nubequa…. And after about 8 months it failed… actually, it was never effective. Then we went to Zytiga… and all the while he has been remaining on Lupron or Firmagon injections… Yet his PSA continued to rise. In April we had AUXIUM scan and it revealed Uptake in paraaortic lymphs… Beginning of May he surgerically had 5 “C” nodes removed and fresh tissue sent to 4 different labs. The results basically were the same genomically etc. Still CDK12 and also ARv7 loss.

Our oncologists both say PARP Inhibitors are not favorable for his type mutation… more likely to respond to PD-1 Inhibitors.

So… this week we should have a more definitive plan.

It’s really scary now that we are seeing Node involvement… Plus, it seems rare for PC to mutate to the abdominal back area… from what I’ve read!

Thank you for your response! You are encouraging!!

[Ahk1 in reply to JolleySprings]

I have pelvic and abdomen LN Mets and was never offered any radiation or other forms of treatment aside first and second line ADT.

[103532 in reply to Ahk1]

That was all that we were offered, initially, however, we pushed for radiation in an effort to throw all options at it and lower the burden.

[Ahk1 in reply to 103532]

Any toxics or side effects from radiation to that area please?

[103532 in reply to Ahk1]

No. So far so good…he ended 39 treatments of 70 gy IMRT concentrating on the abdominal nodes first and full pelvic and prostate bed to try and zap any sleepers. There was one PSMA avid common iliac node, so we think he originally progressed in an ascending pattern. About halfway through the treatment, he took a short nap at lunchtime and had some bloating and light diarrhea, but that was it. We ended six weeks ago, and all symptoms are pretty much gone. He drove two hours round trip very early in the morning to Yale and never missed a day of work. He was able to work from home during all of this. Incidentall prior to this,, we sought a second opinion about whether or not to do the IMRT in addition to the ADT, and they said to go for it!

[103532 in reply to Ahk1]

Our thought was to put them to sleep with ADT then try to kill them in the “hopes” that is their only landing spot.

[103532 in reply to JolleySprings]

Thank you, and I will learn from what they will be offering your husband, who will be in my prayers.

[Ahk1]

1/2017 , I had SRT to prostate bed only at the time of recurrence. So I am not sure if I can do radiation now for these Mets. I am on vacation now for about 7 months.

[103532 in reply to Ahk1]

I read through your bio, and I think you will be managed for a very long time. It appears it is being managed well and kept in good control. Enjoy your vacation. If my husband proceeds similar to your history, I would be guarded but hopeful.

[Ahk1 in reply to 103532]

Thank you very much for your kind and hopfull words. I am very scared to death from the day. Resistance sets in. I hope and your husband does very well. It appears so from his bio too.

[NanoMRI]

General reading suggests Retroperitoneal nodes are associated more with testicular cancer. My left paraaortic nodes were found to be cancerous in my third treatment, salvage extended pelvic lymph node dissection surgery.

[103532 in reply to NanoMRI]

Looks like your pca is really under control! We were advised two years on Abi/pred and 3 years of Lupron. My husband was psa doubling monthly albeit at low levels. Best wishes that you continue to do well!!!

[NanoMRI in reply to 103532]

Thank you. I do not have enough words to express my gratefulness. Yes, almost ten years and four treatments and it seems my beast continues to be 'idle', despite having made it to the para-aortic nodes. After my RP my very low usPSA doubled in less than a year.

I know I have taken a gamble outside of more common treatment paths with my salvage extended pelvic lymph node dissection surgery and only one year on ADT; and that being 'just' bicalutamide. This is why I continue bi-monthly usPSA testing, annual imaging and annual blood biopsy testing.

All the best for you and your husband!