Do I need lymph node dissection?

[FMOH_N]

Had LAPR in beginning of June. Prior to LARP: PSA 6.2, Biopsy: 3+4 with 40% GG4. Histology report after LARP upgraded the cancer to 4+3 with 70% GG4. In addition, Intraductal carcinoma and Cribriform morphology of GG4 is identified. (EPE: negative, SV: negative, bladder neck and lymph vascular invasion: negative, surgical margins: negative, pT2, tumor dimension 14mmx8mm- prostate 36.6ml - 40x50x35mm)

PSA 6 weeks after surgery: <0.1

No lymph node is removed during LARP. Now 3 months later, I am wondering to have a lymph node dissection due to upgrade of cancer and higher risk factor in nomogram (evidencio.com/models/show/1....

The risk factor is 16% which is higher than threshold recommendation values.

Shall I do LN dissection?

[Tall_Allen]

Of course not. As far as you know, you are cured - you have no evidence of disease.

[FMOH_N in reply to Tall_Allen]

Highly appreciate your reply TA.

Yes cured If I was 3+3.

However with GG4, there is no guarantee, 50% chance of microscopic spread? and if this is the case then I can prevent it from further spread (of course this is my belief that I can prevent it from further spread, however, not sure whether this is correct or not).

I don´t know how much PSA will increase by cancer in only one LN, especially if the amount is microscopic.

PSMA PET scan will only be available when PSA reaches 0.2.

[Tall_Allen in reply to FMOH_N]

Cured, because no evidence of disease. You are making up a fictional disease in your mind, causing your own anxiety. Stick to what you know in the present moment.

[allie2020 in reply to Tall_Allen]

I was 3+4 and my very experienced surgeon didn't remove any lymph nodes. I trust his judgment. My tumor was also T2 and I've had all undetectable PSA's for five years. I think you should go with the ultrasensitive PSA tests and try not to worry.

[Justfor_]

No point for it now. It should have been done as part of the RP. The average in Europe is 10-12 nodes, half of them in the States (surgeon's time more expensive there). None, as in your case, not the norm anywhere.

[FMOH_N in reply to Justfor_]

The problem is upgrade of cancer that resulted in higher risk of LN involvement (from 10 to 16%). However, how much I can rely on these monograms that are based on statistical data? Many thanks for your massage.

[Justfor_ in reply to FMOH_N]

Forget the nomograms, they are only good for a posteriori mass analyses. Your RP, by eliminating the bulk of your PSA origination, provided you with a 100x magnifying lens. Just use it. Watch your PSA, at least to the 2nd decimal place and when you have had 5-6 time samples derive your PSADT. This will tell you, better than anything else, your most plobable prognosis.