Lymphadenectomy with HDR Brachy mono?

[SongofFred]

To limit late radiation toxicities and better preserve erectile function, is it possible to have lymph nodes removed surgically instead of having the beam therapy that comes with HDR Brachyboost?

Would the recurrence risk be reduced by the same degree with HDR mono plus lymphadenectomy as it would be with HDR Brachy boost?

Or would there still be areas left uncovered after HDR mono plus lymphadenectomy? Dr. Chang at UCLA says HDR Brachy alone covers the prostate and bed fully, so it seems just the lymph nodes remain.

I know this isn’t common, but they are removed with surgery all the time and I really would like to subject myself to as few late side effects as possible. I’d like to push for it if it provides the same exact benefit.

(This is my fourth post in as many weeks, I do have more questions but don’t want to hog the forum. Please let me know if I’m over-posting )

Thanks for any insight.

[Tall_Allen]

No. And it would be ineffective, even if you could. Removing a few LNs is a bad idea.

[SongofFred in reply to Tall_Allen]

Interesting. Isn’t the only difference between boost and mono HDR that the nodes are dosed in boost? If so, how would removal not have the same effect?

I’m just trying as hard as hell to maintain my erection and it looks like the beam/boost shaves another 20% off my already moderate chance of keeping it.

[Tall_Allen in reply to SongofFred]

You can only remove the cancerous nodes you can see, which are a tiny fraction of all the nodes in the pelvis. Try to protect penile blood vessels with daily Cialis.

[SongofFred in reply to Tall_Allen]

I get it, and nothing is visible at this point.

I am scheduled to have many months of Orgovyx and Nubeqa. Do you know if it’s possible that they might have the horse power to eliminate all microscopic tumor cell activity possible in the lymph nodes if I skipped the beam, or do those therapies just kick the can down the road? (besides assisting with function of radiation)

[Tall_Allen in reply to SongofFred]

Hormone therapy alone never eliminates all cancer. PLND can't either. Only radiation combined with hormone therapy can possibly. The longer you delay, the more it will spread and become incurable.

[SongofFred in reply to Tall_Allen]

Thanks yet again, T-A. I just have to accept it, embrace it, and move forward. You’ve really helped me make up my mind and I’m grateful. My ADT should arrive in a few days.