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microscopic spread

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User
Posted 04 Jun 2016 at 14:26
Hi Everyone,

As many of you know, and thanks for your help and support, I am nearly 4 weeks post RP, and doing ok. What I cant get proper info on is the possible microscopic spread to the local lymph nodes. My surgeon did pathology on my prostate during the op to check the margins which were all clear. But I understand that sometimes a surgeon checks lymph nodes during the op and if they find microscopic spread, they stop the op.

Basically, what experience of this does anyone know about....has anyone had clear mri, no observational sign of node spread, but then later histology has found some? Does removal of the nodes therefore remove the microscopic spread, and that's it? Or what happens next?

Thanks folks,

David

User
Posted 04 Jun 2016 at 20:31

Hi David,

At my initial diagnosis, with MRI scan my Doctors could tell that lymph node/s near the prostate were enlarged suggesting that they might be harbouring cancer.

The first good sign was that the enlarged node didn't shrink while I was on HT, which suggested that the swelling was benign, however the doctors wanted to make sure and so I had lymph nodes removed, an operation known as PLND (Pelvic Lymph Node Dissection), it is all written up in my profile so I won't repeat it here.

However when I was talking to the doctors about it, we used the analogy that the lymphatic system is like the body's drainage system, and lymph nodes are the equivalent of 'u' bends, or waste traps.

If cancerous cells break free from your tumour they can spread about the body through the blood stream or lymph system.  However white cells in the blood stream tend to mop up anything that doesn't look quite right, so the rogue cancer cells spreading in the blood are at risk, which is why as often as not the initial spread is via the lymph system.  The first place that rogue cells are likely to fetch up is in the lymph nodes, which is why the doctors tend to look there.

Say your wife had lost her engagement ring down the drain, the first place you would look is in the U bend, the same principle applies, and while there is no guarantee that any loose cells will fetch up in the lymph nodes, the fact that your lymph nodes are found to be clear is a good sign.

Having said that, I wouldn't encourage anyone to suggest that they have PLND, my doctors opened me up to look at one lymph node then decided to take out, they use the word 'harvest', 12 of them.  Imagine if your plumber took 12 waste traps out of your house, there would be a mess on the floor, and it is the same with PLND, I ended up with lymphoceles, which are basically puddles of lymphatic fluid inside the body, and these in turn got infected and caused all sorts of trouble, getting in the way of EBRT etc.  So unless your doctor suggests it, don't go there.

:)

Dave

Edited by member 04 Jun 2016 at 20:37  | Reason: Not specified

User
Posted 04 Jun 2016 at 20:09

'Ello David,

As Chris has already stated, there are no guarantees in this game...

Some lymph nodes were routinely removed for dissection as a precaution during my surgery  ( I doubt they checked them whilst surgery was in progress ) 

The best you can hope for is a good histology result...... what happens a few years down the line is in the lap of the gods I think...

There may well be microscopic cells that have escaped and are floating around ...but until they decide to set up camp somewhere there is currently no way of  detecting them other than with a regular PSA test.

The exact whereabouts of rouge cells if they are indeed detected at a later stage is not an exact science either as I understand things..

Luther

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User
Posted 04 Jun 2016 at 19:13

Hi David
Difficult to reply to. Most Urologists warn you that even if the operation is 100% successful , there may already have been some micro spread which will appear at a later date. Sadly many men post op have great results , only for the PSA to rise again a couple of years later.
My cancer , although quite aggressive with a PSA of 15 rapidly rising to 43 , was very hard to find and all scans were inconclusive. So they operated and took 18 lymph nodes out at the same time. Unfortunately 5 of them were cancerous and my post op PSA was 1.5 quickly rising to 2.4 at 12 weeks. I was offered RT but refused on the grounds that they believe there is spread further afield. So HT it is now , but stopping August and letting PSA rise for a very accurate PET scan end of year , so we know exactly what we are dealing with.
This is a horrible ride to be on for everyone , and quite difficult to get off and truly relax. Wait for your results and be guided by them and the doctors. And of course report back to us because there are some very knowledgeable people on here.
Chris

User
Posted 04 Jun 2016 at 20:06

Thanks Chris. I presume removing affected lymph nodes does sometimes mean that's an end to it?

User
Posted 04 Jun 2016 at 20:09

'Ello David,

As Chris has already stated, there are no guarantees in this game...

Some lymph nodes were routinely removed for dissection as a precaution during my surgery  ( I doubt they checked them whilst surgery was in progress ) 

The best you can hope for is a good histology result...... what happens a few years down the line is in the lap of the gods I think...

There may well be microscopic cells that have escaped and are floating around ...but until they decide to set up camp somewhere there is currently no way of  detecting them other than with a regular PSA test.

The exact whereabouts of rouge cells if they are indeed detected at a later stage is not an exact science either as I understand things..

Luther

User
Posted 04 Jun 2016 at 20:31

Hi David,

At my initial diagnosis, with MRI scan my Doctors could tell that lymph node/s near the prostate were enlarged suggesting that they might be harbouring cancer.

The first good sign was that the enlarged node didn't shrink while I was on HT, which suggested that the swelling was benign, however the doctors wanted to make sure and so I had lymph nodes removed, an operation known as PLND (Pelvic Lymph Node Dissection), it is all written up in my profile so I won't repeat it here.

However when I was talking to the doctors about it, we used the analogy that the lymphatic system is like the body's drainage system, and lymph nodes are the equivalent of 'u' bends, or waste traps.

If cancerous cells break free from your tumour they can spread about the body through the blood stream or lymph system.  However white cells in the blood stream tend to mop up anything that doesn't look quite right, so the rogue cancer cells spreading in the blood are at risk, which is why as often as not the initial spread is via the lymph system.  The first place that rogue cells are likely to fetch up is in the lymph nodes, which is why the doctors tend to look there.

Say your wife had lost her engagement ring down the drain, the first place you would look is in the U bend, the same principle applies, and while there is no guarantee that any loose cells will fetch up in the lymph nodes, the fact that your lymph nodes are found to be clear is a good sign.

Having said that, I wouldn't encourage anyone to suggest that they have PLND, my doctors opened me up to look at one lymph node then decided to take out, they use the word 'harvest', 12 of them.  Imagine if your plumber took 12 waste traps out of your house, there would be a mess on the floor, and it is the same with PLND, I ended up with lymphoceles, which are basically puddles of lymphatic fluid inside the body, and these in turn got infected and caused all sorts of trouble, getting in the way of EBRT etc.  So unless your doctor suggests it, don't go there.

:)

Dave

Edited by member 04 Jun 2016 at 20:37  | Reason: Not specified

User
Posted 04 Jun 2016 at 20:47

Unfortunately Dave, if it has been found in the lymph nodes then it may have spread around the lymph system already. Luther is so right that you can only hope for good histology and go from there. It's hard not worrying but I'm finding its all been going on so long I'm getting bored of it now and ignore it a bit. And a few glasses of wine at night helps a lot. It can be very difficult to find spread after the op. My PSA post op suggested quite a bit of cancer remaining. If it was all one tumour the size of a garden pea , then it would be easier to spot. However that pea sized amount of cancer could be split between multiple sites making it very hard to spot. I had a PET scan post op and I think they were hoping to see a lump or hot-spot where they had left something behind. The fact they didn't indicates micro mets spread. If they let my PSA rise a bit higher then they think they may find it. But even then there could be little ones not detected. Like I said , I'm getting a bit bored of it. It can take over your life. Now where's that glass of wine ....

User
Posted 05 Jun 2016 at 08:17

Dave

During the RP it is quite common practice to remove some nodes to check that the cancer hasnt spread to them. I am surprised that your surgeon did not discuss this with you pre-op. I had 16 modes removed which were thankfully all clear.

Wait for the histology to see how sucessful your op was

Bri

User
Posted 05 Jun 2016 at 10:07

Hi Bri

Yes he did say they would be removed during the op, but we didn't discuss what would happen if they're positive. If they know beforehand then often they don't proceed with the RP, so I believe. He must be confident bit u never know!

 
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