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Treatment option - I'm confused

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User
Posted 09 Nov 2016 at 21:33
Good evening

So, I had my meeting with the consultant. My results:

T3aN1MX. Gleason 7 (3+4 on one side, 4+3 on the other). Extensive peri neural spread.

The lymph node is interesting. They have given me N1. I thought that meant cancer was present. The consultant said the scan showed enlarged lymph nodes but they didn't present as typically cancerous. So why the N1?

Anyway, I'll have a PET/CT scan and he said he hopes to operate in two weeks' time if the PET scan allows him. If I understood him correctly, he said he'd operate even if only a few lymph nodes were affected. I thought they didn't do that.

Can anyone offer any insight? I'm 46, it's bigger than he'd like, and he wants it out ASAP. I have no time to delay. He said the potential narrow endow of opportunity is about to shut if it hasn't done do already.

Walter

User
Posted 10 Nov 2016 at 04:51

Sorry, some of it doesn't make any sense when set against normal practice. N1 usually used when it has been observed to be in lymph nodes. The extensive perineural spread is atypical to surgery as well. All I can suggest is that you satisfy yourself that the surgeon isn't just excited at the opportunity of operating on an unusual case ... a couple of weeks wouldn't make any difference whatever he says about wanting it out asap and if you were my husband or brother I would want you to see an oncologist before anyone comes near you with a knife.

One thing we can clear up - if the suspect affected lymph nodes are in the vicinity of the prostate they can be removed during RP in the hope that they were local spread rather than via lymphatic system. My father in law declined RP or RT/HT but he did have the affected nodes removed.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 10 Nov 2016 at 04:55

Afterthought ... ask him, if he puts all your data into the nomogram what is the predicted outcome in terms of likelihood that adjuvant or salvage treatment will be needed and survival to 10 years. If it is poor odds then you might question why you would risk the side effects for little benefit. If the odds are good it is a no-brainer.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 10 Nov 2016 at 07:01

Yes I checked my previous answer to you and as Lyn says , if the lymph nodes are easily accessible they can remove them during the op aswell. However there is forever a worry that micro spread could already be occurring via the vast lymphatic system , and pop up again at a later point somewhere else.
Sending best wishes

User
Posted 10 Nov 2016 at 07:30
Lyn, I wish I had you in my appointment! I'm being treated at Wexham Park and I am told they are good at this. I think it was possibly the first place, or at least one of them, to do the DaVinci robot. I trusted my urologist because of his reputation but am now having second thoughts.

I suppose the PET scan will confirm lymph involvement.

Just want to run away and hide today but a big day at work so it'll hopefully take my mind off things.

Walter

Edited by member 10 Nov 2016 at 07:31  | Reason: Not specified

User
Posted 10 Nov 2016 at 13:48

Hi Walter I had a lymph node removed prior to my op as surgeon wanted to make sure of no spread as they where up, I presume he meant enlarged, all came back clear and lymph nodes on post op report showed clear . Andy

 
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