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Lymph node disection.

User
Posted 23 Jan 2020 at 21:26

Hi All,
I was recently diagnosed with a T2 N0 M0, Gleason 4+4
and am having a Radical Prosectomy this Monday.

I am undecided on the question of Lymph node dissection.
I have been told that there is a 15% chance of undetected 
metastais. These would usually be detected in Lymph node 
dissection, but would also show up in post op PSA tests. 
As far as I understand, there would be no difference in 
further treatment, so I can't see an advantage of dissection.
On the other hand, removing lymph nodes does have its own
risks such as legs swelling, so I feel it is not worth doing unless
there is a clear clinical advantage.

On the other hand lymph node dissection is standard procedure
in high risk cancers, and as a non medical person, I am nervous about going against the 
standard procedure.

What do people here think? Am I missing something?
And are there any papers I should read to learn more about 
the subject. 

Thanks,
Amnon


 
User
Posted 23 Jan 2020 at 23:43
John wasn't given the choice, sorry. He had a small number removed, they were clear, he has had no side effects from that. Lymphodema is more of a risk where significant numbers of lymph nodes are removed; not usually a problem just for one or two being removed for sampling. I suspect that the relief of being told the nodes were clear might outweigh the small risk of odema for men who are very anxious but you are correct that it wouldn't make any difference to the medium term treatment path.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 24 Jan 2020 at 05:51
I had the sum total of 18 removed bilaterally during surgery. Sadly five were cancerous. I don’t think my body suffered in any way due to this though , although I stayed in a hospital a while longer as they were draining quite a bit too much.

If life gives you lemons , then make lemonade
User
Posted 24 Jan 2020 at 11:58
Your surgeon should know what to remove when he sees what’s what. I had two or three lymph nodes removed, of which one tested cancerous.

My surgeon said the chance of lymphoedema post-operative is around 3%, although my feet did swell up when I was in the Caribbean last year. As did those of Her Loveliness, who hasn’t got a prostate either.

Must’ve been the heat!

Best of luck.

Cheers, John.
User
Posted 29 Jan 2020 at 17:15

Just back home from RP.
At the end, I did not do lymph node dissection.
With the advent of PSMA imaging (which can detect tumors as small as 0.2mm)
the jury is still out about whether Lymph sampling improves outcomes.
Many articles in Urology journals on the issue, but most inconclusive.

User
Posted 18 Feb 2020 at 22:57
I had all my left axial lymph nodes (all 27 of them) removed because two were cancerous following a melanoma (this is the standard treatment and if you don't agree they may not offer you other treatments, which I regard as heinous); they were all clear. I have to mollycoddle my left arm a bit now. I'm not sure I'd have them removed if I did it all again, so I think you made the right decision.
User
Posted 19 Feb 2020 at 11:46
Simple fact: if it's in the bin it ain't going to spread!
User
Posted 19 Feb 2020 at 13:48
In Leeds, they only remove lymph nodes if there is a reason to suspect node involvement and as Humus man says, lymph node sampling makes little difference to the immediate next steps as they would likely wait to see if the PSA rises post-op before offering RT, long term HT or chemo anyway. However, you are over-optimistic about improved imaging and what difference that might make - there remains a proportion of prostate cancers that simply do not show on scans, even with the best tracers available.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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User
Posted 23 Jan 2020 at 23:43
John wasn't given the choice, sorry. He had a small number removed, they were clear, he has had no side effects from that. Lymphodema is more of a risk where significant numbers of lymph nodes are removed; not usually a problem just for one or two being removed for sampling. I suspect that the relief of being told the nodes were clear might outweigh the small risk of odema for men who are very anxious but you are correct that it wouldn't make any difference to the medium term treatment path.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 24 Jan 2020 at 05:51
I had the sum total of 18 removed bilaterally during surgery. Sadly five were cancerous. I don’t think my body suffered in any way due to this though , although I stayed in a hospital a while longer as they were draining quite a bit too much.

If life gives you lemons , then make lemonade
User
Posted 24 Jan 2020 at 11:58
Your surgeon should know what to remove when he sees what’s what. I had two or three lymph nodes removed, of which one tested cancerous.

My surgeon said the chance of lymphoedema post-operative is around 3%, although my feet did swell up when I was in the Caribbean last year. As did those of Her Loveliness, who hasn’t got a prostate either.

Must’ve been the heat!

Best of luck.

Cheers, John.
User
Posted 27 Jan 2020 at 21:40
I wasn't given the option and they removed 10 lymph nodes on each side (all clear luckily), lots of swelling for maybe two weeks but then no problem. My understanding is it is better to do lymph node dissection for cancer control, which should I guess be the main consideration for relatively young people like you. Also younger people should have less risk of complications I suppose. Haven't looked at the literature though!
User
Posted 29 Jan 2020 at 17:15

Just back home from RP.
At the end, I did not do lymph node dissection.
With the advent of PSMA imaging (which can detect tumors as small as 0.2mm)
the jury is still out about whether Lymph sampling improves outcomes.
Many articles in Urology journals on the issue, but most inconclusive.

User
Posted 18 Feb 2020 at 22:57
I had all my left axial lymph nodes (all 27 of them) removed because two were cancerous following a melanoma (this is the standard treatment and if you don't agree they may not offer you other treatments, which I regard as heinous); they were all clear. I have to mollycoddle my left arm a bit now. I'm not sure I'd have them removed if I did it all again, so I think you made the right decision.
User
Posted 19 Feb 2020 at 11:46
Simple fact: if it's in the bin it ain't going to spread!
User
Posted 19 Feb 2020 at 13:48
In Leeds, they only remove lymph nodes if there is a reason to suspect node involvement and as Humus man says, lymph node sampling makes little difference to the immediate next steps as they would likely wait to see if the PSA rises post-op before offering RT, long term HT or chemo anyway. However, you are over-optimistic about improved imaging and what difference that might make - there remains a proportion of prostate cancers that simply do not show on scans, even with the best tracers available.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
 
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