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Lymph Nodes- is there any point

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User
Posted 12 Dec 2023 at 01:58

Hi


I wonder. If as someone recently correctly stated, the lymph nodes are like a highway, then why radiate the lymph nodes outside of the prostate. Surely if the cancer has invaded these lymph nodes then it is most likely to have commenced travelling the highway? If indeed it breaks out then surely further spread is inevitable and the only option is to slow the progression of the disease?


Rory 


 

User
Posted 12 Dec 2023 at 08:14

Lymph fluid is basically water that leaks through cell walls and blood vessels into the spaces between them, and is mopped up by the lymphatic system which collects this and adds in loads of antibodies and T cells to kill any bacteria and viruses present. Areas of injury or infection also get swamped with lymph to try and clean them up and disinfect them.


Lymph nodes filter out and kill any cells in lymph fluid, including cancer cells. While they're successfully doing this, you're OK. Eventually however, either some cancer cells leak through, or they're filtered out but not killed, and grow in the lymph node. Then you're in trouble.


Lymph fluid passes through many lymph nodes as it passes back through your body heading towards your collar bone area, where after multiple filtering, it drains back in to your blood stream. If cancer is found only in the lymph nodes immediately draining your prostate of lymph, that's likely to be more curable than if it's found further along the pathway, which is why staging identifies it as N1 when near the prostate, rather than distant lymph nodes which is identified as M1a as it's already leaked through many lymph nodes and further micro-mets are likely to have been established even if not yet found.


With radiotherapy of high risk cases, prophylactic treatment of pelvic lymph nodes is sometimes undertaken in higher risk cases even if it wasn't found in them, just in case micro-mets had already set up in there but not shown on scans. (One of the objectives of the PIVOTALboost trial is to see how effective this is at preventing spread which would otherwise have happened from micro-mets in lymph nodes.) Similarly with surgery, pelvic lymph node dissection (PLND) is sometimes included, hoping to go as far as taking all nodes with any mets in them, which you can only be reasonably sure of if you've gone as far as the first node in the chain with no mets in them. The trouble here is that may involve taking nodes which drain other areas such as groin and/or legs, leaving those areas with no lymph no drainage anymore, and lymphedema where water can't drain anymore, which is debilitating and not resolvable. (So I tend to suggest anyone going in to surgery with the expectation of extensive PLDN really considers radiotherapy to include pelvic lymph nodes instead, as that can cure cancer in the lymph nodes with a better prospect of leaving them still working afterwards.)


Interestingly, if you have a tattoo done, much of the ink will leak and be mopped up by the lymph system, and it tattoos the lymph nodes as it passes through them and they filter out the dyes. When bodies have been recovered from crime sites after attempts to prevent their identity, which often involves destroying identifying features such as tattoos, they have still be identified from the missing tattoos by finding matching coloured inks staining the relevant lymph nodes.

Edited by member 12 Dec 2023 at 08:54  | Reason: Not specified

User
Posted 12 Dec 2023 at 19:35

Originally Posted by: Online Community Member


Lymph fluid is basically water that leaks through cell walls and blood vessels into the spaces between them, and is mopped up by the lymphatic system which collects this and adds in loads of antibodies and T cells to kill any bacteria and viruses present. Areas of injury or infection also get swamped with lymph to try and clean them up and disinfect them.


Lymph nodes filter out and kill any cells in lymph fluid, including cancer cells. While they're successfully doing this, you're OK. Eventually however, either some cancer cells leak through, or they're filtered out but not killed, and grow in the lymph node. Then you're in trouble.


Lymph fluid passes through many lymph nodes as it passes back through your body heading towards your collar bone area, where after multiple filtering, it drains back in to your blood stream. If cancer is found only in the lymph nodes immediately draining your prostate of lymph, that's likely to be more curable than if it's found further along the pathway, which is why staging identifies it as N1 when near the prostate, rather than distant lymph nodes which is identified as M1a as it's already leaked through many lymph nodes and further micro-mets are likely to have been established even if not yet found.


With radiotherapy of high risk cases, prophylactic treatment of pelvic lymph nodes is sometimes undertaken in higher risk cases even if it wasn't found in them, just in case micro-mets had already set up in there but not shown on scans. (One of the objectives of the PIVOTALboost trial is to see how effective this is at preventing spread which would otherwise have happened from micro-mets in lymph nodes.) Similarly with surgery, pelvic lymph node dissection (PLND) is sometimes included, hoping to go as far as taking all nodes with any mets in them, which you can only be reasonably sure of if you've gone as far as the first node in the chain with no mets in them. The trouble here is that may involve taking nodes which drain other areas such as groin and/or legs, leaving those areas with no lymph no drainage anymore, and lymphedema where water can't drain anymore, which is debilitating and not resolvable. (So I tend to suggest anyone going in to surgery with the expectation of extensive PLDN really considers radiotherapy to include pelvic lymph nodes instead, as that can cure cancer in the lymph nodes with a better prospect of leaving them still working afterwards.)


Interestingly, if you have a tattoo done, much of the ink will leak and be mopped up by the lymph system, and it tattoos the lymph nodes as it passes through them and they filter out the dyes. When bodies have been recovered from crime sites after attempts to prevent their identity, which often involves destroying identifying features such as tattoos, they have still be identified from the missing tattoos by finding matching coloured inks staining the relevant lymph nodes.



 


Andy,


Seriously.


Its genuinely difficult to measure how invaluable you are to this site.


 


Jamie.

User
Posted 12 Dec 2023 at 07:43

There are two types of lymph node involvement:


1. When prostate cancer is identified in lymph nodes away from the immediate pelvic area, they have indeed set off down the highway and RT to the prostate bed / pelvic area would be pointless. This is described as M1a on the diagnosis letter.


2. imagine the lymph nodes immediately next to the prostate are like a colander / sieve - as the lymphatic fluid flows through the prostate, it picks up tiny cancer cells and carries them into the nearest lymph node where the colander / sieve filters them out and stops them going off down the highway. This is described as N1 or N0 and RT to the pelvic area is very much worthwhile!

Edited by member 23 Dec 2023 at 18:37  | Reason: to clarify info

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 12 Dec 2023 at 20:27

Adrianus. My surgeon told me he takes out as many nodes as he can see. That ended up being 36 nodes. It resulted in a lymphocele in my groin area and lymphoedema in my right leg. That doesn't happen to everyone of course. I was just unlucky but in hindsight radiotherapy to my lymph nodes may have given me a better outcome.

User
Posted 14 Dec 2023 at 21:17
Colwick Chris, Wiosal, you are right that lymph vessels are typically drawn in textbooks as running from node to node, so something would have had to go through the nearest nodes to get to ones further distant.

While that is believed to be the case, lymph vessels are mostly extremely small and almost impossible to see. The pictures are based on just a few careful studies using specialised techniques, and I don't think those definitely rule out the possibility of there being occasional vessels which bypass the nearest nodes.

In addition:
(1) all of us are different. While the descriptions may well be true for the majority of people as far as the scientists could tell that doesn't mean they are necessarily true for everyone and for you in particular.
(2) what makes a cancer establish a secondary in one place and not another is also poorly understood. It is possible most cells were stopped at the first lymph node they got to and destroyed without establishing a secondary there, but a few cells managed to pass beyond and succeeded in establishing a secondary at a more distant node.
User
Posted 24 Dec 2023 at 15:09

Originally Posted by: Online Community Member


Thanks Lyn.


Do you know if a prostatectomy is cheaper [for the NHS] than RT/HT treatment?


Jules



RT/HT used to be more expensive, but with increasing use of hypofractionation, that might not be the case anymore. I haven't seen any figures since well before COVID.


We were told that LDR Brachytherapy was the most expensive operation the hospital does, mainly because of the number of different consultants required in theatre during the procedure. (IIRC, it was urology, oncology, and medical physics.)

Edited by member 24 Dec 2023 at 15:14  | Reason: Not specified

User
Posted 26 Dec 2023 at 13:25

Reading don't have one either. They send patients to Oxford or Mount Vernon for PET scans.


However, hospitals without their own PET scanner offer far fewer PET scans to their patients. I had assumed this might down to cost, but an oncologist said to me it's also familiarity - oncologists in centres without PET scanners are less experienced in using them, often don't realise how useful they are (some have even been skeptical), and how often they cause in changes to treatment which improve outcomes.


There is a big shortage of PET scanning capacity though. This is causing a waiting period which is itself unsuitable for some patients, resulting in treatment having to go ahead without waiting for a scan.

User
Posted 15 Mar 2024 at 12:58

I was diagnosed with Prostate cancer in February 2022, T3B N1 M0. Gleason 8,PSA 252.


 


I’ve had 6 chemotherapy sessions and 37 radiotherapy sessions. I’m also on hormone therapy.


 


First PSA test after completion of treatment 2.1


 


Second test four months later 0.5


 


Third test 0.2


 


My fourth test is in March


 


The March results have just come in at less than 0.1 which is quite a relief.


 


The real issue is what happens to the PSA in years time when I come off ADT.


 


Given what I presented with,I’m not holding out much hope but at least I am okay for now.


 


I thought I would post an update, if it’s of any interest to anyone.


 

User
Posted 12 Dec 2023 at 07:14

Rory, I had surgery nearly ten years ago, followed by salvage RT three years later. In the past eighteen months I have twice had  SABR treatment to two separate lymph node tumors. For me a possible cure route was preferable to a life time of control.


Thanks Chris 


 

User
Posted 15 Dec 2023 at 08:51

I can’t find the article again. But I read somewhere that cancer cells just in the lymph nodes alone don’t usually cause a problem, they need to work with the tumour. So I’m hoping that as dh doesn’t have a tumour in the prostate (yet!) that that is a good thing. The brachytherapy has killed it off. 

User
Posted 23 Dec 2023 at 18:35

Originally Posted by: Online Community Member


Lyn


Surely N0 relates to not being in the lymph nodes. I think your post suggests otherwise.


Thanks


Rory 



Strictly speaking, N0 indicates that there are no mets in the lymph nodes. N1 indicates that there is cancer in the lymph nodes close to the prostate. M1a indicates that the cancer has metastasised to lymph nodes further afield. The problem is that we are seeing more and more commonly now that men with just one or two potentially affected nodes in the pelvis are being scored as N0 and offered treatment as if the nodes were not affected.   

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 23 Dec 2023 at 23:58

Originally Posted by: Online Community Member


Originally Posted by: Online Community Member
The problem is that we are seeing more and more commonly now that men with just one or two potentially affected nodes in the pelvis are being scored as N0 and offered treatment as if the nodes were not affected.


Surely that's a big problem??!!


Jules



I think that depends on your perspective, Jules. From an NHS resources point of view, it means that more men are being offered RP despite knowing that there is a significant chance of needing adjuvant or salvage RT whereas, in the past, they would have been advised to have RT / HT straight off. From the patient's point of view, it could be a good thing or a bad thing - the man might be thrilled to get RP and it is successful (or removing the bulk appears to slow down progression) OR the man may not understand the significant risk of recurrence and is devastated when the RP doesn't get rid of it. Based on what I have seen here over the years, the good / bad effect seems to depend an awful lot on whether the urologist explains the risk properly or glosses over it.  

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 24 Dec 2023 at 00:03

Originally Posted by: Online Community Member


Hi Lyn 


I was T3B N1 M0 and had full pelvic radiation, chemotherapy and hormone therapy.


That said, my PSA was 252 but the bone scan and full body scan were negative.


I was told there was a very significant risk of micro metastatic disease.


My report stated that only one lymph node was involved.



Hi Roger, there may have been only one lymph node showing as affected on the scans but,  as you will have realised, there is a possibility of micromets in many lymph nodes which may show themselves at some point in the future. That is pretty much what happened to Chris-J - the scans were clear for ages. I suppose it also matters whether your one lymph node was adjacent to the prostate or somewhere remote like under your armpit :-/   Either way, you have given it all barrels and will hopefully still be posting here in 10 years! 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 24 Dec 2023 at 17:05

I have just read your conversations about lymph nodes with interest. 


My original PSA was 82 and MRI score T3bN0 M0 and Gleason score of 4+5=9


I've just had my first appointment with the Oncologist on Thursday and he didn't fill me with much confidence. He said I probably would be on Hormone therapy for 2 years and start Radiotherapy in February consisting of 4 weeks treatment. My wife asked him what areas would he be targeting with the radiotherapy and he just said the Prostate and seminal vesicles. I followed this by saying seeing as its an aggressive form of cancer wouldn't it be best to include the lymph nodes? He had a think about it and agreed that's probably best!!


I also said what about doing a PET scan because nearly 3 months had passed since the original scans and the cancer could have spread. He said it would have been a good idea earlier but now that Hormone therapy had started it wasn't necessary. 


We made it aware that things have progressed slowly so far but now seem to moving on at a quicker pace. That was more or less it. Later in the day he called me and said he'd been reviewing my case again with a colleague and offered me a one off high doze of Brachytherapy at Christies in Manchester. I accepted this but thought he's only doing this because they haven't  given me the best care. 


The punch line is if we hadn't have pushed he wouldn't have included the lymph nodes in the radiotherapy.

User
Posted 25 Dec 2023 at 06:21

John


It seems to me that it's all a bit.of a lottery. I don't feel that I have had the best treatment. My lymph nodes have not been radiated, but that's just how it is. I have also noted that although my PSA is 0.34 after radiation and 12 months HT and the medics seem happy I cannot but note others down to levels significantly lower and often down from greater highs. 


What can one do, not a lot other than enjoy each day. I love the positivity of all those who heroically declare that their cancer won't define them. My cancer may not have defined me but it has certainly changed my life. Happy Christmas ⛄.


Rory

User
Posted 26 Dec 2023 at 14:58

Originally Posted by: Online Community Member
Following RP and RT ten years ago. They have detected a 4mm lesion in a pelvic lymph node with a PSMA scan. They did not discover anything else apart from some OA. The prostate bed was clear. Does this mean the PCa has been lurking in that lymph node for years. I am now waiting for for an appointment in January to see if SABr treatment is possible/appropriate

Thanks
Bri


You sound similar to dh with it in a lymph node. Though dh has it in more than one lymph node. However it is 9 years from original treatment and the original treatment worked as nothing found in the prostate. It’s amazing it can sit in the lymph nodes all that time without putting out psa (dh’s psa was 0.01 for almost 5 years) As I said above I don’t get how it got into nodes further up into the pelvis, but none in the nodes close to the prostate. The consultant did say they must’ve been there all along. In that case….its annoying they don’t just do a psma at initial diagnosis. 

User
Posted 15 Mar 2024 at 16:53

Andy is one incredibly smart and helpful person along with a few others on here that have helped me and many others in dark times carry on with this disease i personally can't thank you all enough for all your help and support you know who you all are thanks again garry 👍

Show Most Thanked Posts
User
Posted 12 Dec 2023 at 07:14

Rory, I had surgery nearly ten years ago, followed by salvage RT three years later. In the past eighteen months I have twice had  SABR treatment to two separate lymph node tumors. For me a possible cure route was preferable to a life time of control.


Thanks Chris 


 

User
Posted 12 Dec 2023 at 07:43

There are two types of lymph node involvement:


1. When prostate cancer is identified in lymph nodes away from the immediate pelvic area, they have indeed set off down the highway and RT to the prostate bed / pelvic area would be pointless. This is described as M1a on the diagnosis letter.


2. imagine the lymph nodes immediately next to the prostate are like a colander / sieve - as the lymphatic fluid flows through the prostate, it picks up tiny cancer cells and carries them into the nearest lymph node where the colander / sieve filters them out and stops them going off down the highway. This is described as N1 or N0 and RT to the pelvic area is very much worthwhile!

Edited by member 23 Dec 2023 at 18:37  | Reason: to clarify info

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 12 Dec 2023 at 08:14

Lymph fluid is basically water that leaks through cell walls and blood vessels into the spaces between them, and is mopped up by the lymphatic system which collects this and adds in loads of antibodies and T cells to kill any bacteria and viruses present. Areas of injury or infection also get swamped with lymph to try and clean them up and disinfect them.


Lymph nodes filter out and kill any cells in lymph fluid, including cancer cells. While they're successfully doing this, you're OK. Eventually however, either some cancer cells leak through, or they're filtered out but not killed, and grow in the lymph node. Then you're in trouble.


Lymph fluid passes through many lymph nodes as it passes back through your body heading towards your collar bone area, where after multiple filtering, it drains back in to your blood stream. If cancer is found only in the lymph nodes immediately draining your prostate of lymph, that's likely to be more curable than if it's found further along the pathway, which is why staging identifies it as N1 when near the prostate, rather than distant lymph nodes which is identified as M1a as it's already leaked through many lymph nodes and further micro-mets are likely to have been established even if not yet found.


With radiotherapy of high risk cases, prophylactic treatment of pelvic lymph nodes is sometimes undertaken in higher risk cases even if it wasn't found in them, just in case micro-mets had already set up in there but not shown on scans. (One of the objectives of the PIVOTALboost trial is to see how effective this is at preventing spread which would otherwise have happened from micro-mets in lymph nodes.) Similarly with surgery, pelvic lymph node dissection (PLND) is sometimes included, hoping to go as far as taking all nodes with any mets in them, which you can only be reasonably sure of if you've gone as far as the first node in the chain with no mets in them. The trouble here is that may involve taking nodes which drain other areas such as groin and/or legs, leaving those areas with no lymph no drainage anymore, and lymphedema where water can't drain anymore, which is debilitating and not resolvable. (So I tend to suggest anyone going in to surgery with the expectation of extensive PLDN really considers radiotherapy to include pelvic lymph nodes instead, as that can cure cancer in the lymph nodes with a better prospect of leaving them still working afterwards.)


Interestingly, if you have a tattoo done, much of the ink will leak and be mopped up by the lymph system, and it tattoos the lymph nodes as it passes through them and they filter out the dyes. When bodies have been recovered from crime sites after attempts to prevent their identity, which often involves destroying identifying features such as tattoos, they have still be identified from the missing tattoos by finding matching coloured inks staining the relevant lymph nodes.

Edited by member 12 Dec 2023 at 08:54  | Reason: Not specified

User
Posted 12 Dec 2023 at 19:35

Originally Posted by: Online Community Member


Lymph fluid is basically water that leaks through cell walls and blood vessels into the spaces between them, and is mopped up by the lymphatic system which collects this and adds in loads of antibodies and T cells to kill any bacteria and viruses present. Areas of injury or infection also get swamped with lymph to try and clean them up and disinfect them.


Lymph nodes filter out and kill any cells in lymph fluid, including cancer cells. While they're successfully doing this, you're OK. Eventually however, either some cancer cells leak through, or they're filtered out but not killed, and grow in the lymph node. Then you're in trouble.


Lymph fluid passes through many lymph nodes as it passes back through your body heading towards your collar bone area, where after multiple filtering, it drains back in to your blood stream. If cancer is found only in the lymph nodes immediately draining your prostate of lymph, that's likely to be more curable than if it's found further along the pathway, which is why staging identifies it as N1 when near the prostate, rather than distant lymph nodes which is identified as M1a as it's already leaked through many lymph nodes and further micro-mets are likely to have been established even if not yet found.


With radiotherapy of high risk cases, prophylactic treatment of pelvic lymph nodes is sometimes undertaken in higher risk cases even if it wasn't found in them, just in case micro-mets had already set up in there but not shown on scans. (One of the objectives of the PIVOTALboost trial is to see how effective this is at preventing spread which would otherwise have happened from micro-mets in lymph nodes.) Similarly with surgery, pelvic lymph node dissection (PLND) is sometimes included, hoping to go as far as taking all nodes with any mets in them, which you can only be reasonably sure of if you've gone as far as the first node in the chain with no mets in them. The trouble here is that may involve taking nodes which drain other areas such as groin and/or legs, leaving those areas with no lymph no drainage anymore, and lymphedema where water can't drain anymore, which is debilitating and not resolvable. (So I tend to suggest anyone going in to surgery with the expectation of extensive PLDN really considers radiotherapy to include pelvic lymph nodes instead, as that can cure cancer in the lymph nodes with a better prospect of leaving them still working afterwards.)


Interestingly, if you have a tattoo done, much of the ink will leak and be mopped up by the lymph system, and it tattoos the lymph nodes as it passes through them and they filter out the dyes. When bodies have been recovered from crime sites after attempts to prevent their identity, which often involves destroying identifying features such as tattoos, they have still be identified from the missing tattoos by finding matching coloured inks staining the relevant lymph nodes.



 


Andy,


Seriously.


Its genuinely difficult to measure how invaluable you are to this site.


 


Jamie.

User
Posted 12 Dec 2023 at 19:55

When I had my prostatectomy he took out 9 lymph nodes is this normal procedure?

Edited by member 12 Dec 2023 at 19:56  | Reason: Not specified

User
Posted 12 Dec 2023 at 20:27

Adrianus. My surgeon told me he takes out as many nodes as he can see. That ended up being 36 nodes. It resulted in a lymphocele in my groin area and lymphoedema in my right leg. That doesn't happen to everyone of course. I was just unlucky but in hindsight radiotherapy to my lymph nodes may have given me a better outcome.

User
Posted 12 Dec 2023 at 20:48

Interestingly, if you have a tattoo done, much of the ink will leak and be mopped up by the lymph system, and it tattoos the lymph nodes as it passes through them and they filter out the dyes. When bodies have been recovered from crime sites after attempts to prevent their identity, which often involves destroying identifying features such as tattoos, they have still be identified from the missing tattoos by finding matching coloured inks staining the relevant lymph nodes.


 


It's (almost ) worth joining this club just for nuggets like that!

User
Posted 13 Dec 2023 at 21:19

Originally Posted by: Online Community Member


Lymph fluid is basically water that leaks through cell walls and blood vessels into the spaces between them, and is mopped up by the lymphatic system which collects this and adds in loads of antibodies and T cells to kill any bacteria and viruses present. Areas of injury or infection also get swamped with lymph to try and clean them up and disinfect them.


Lymph nodes filter out and kill any cells in lymph fluid, including cancer cells. While they're successfully doing this, you're OK. Eventually however, either some cancer cells leak through, or they're filtered out but not killed, and grow in the lymph node. Then you're in trouble.


Lymph fluid passes through many lymph nodes as it passes back through your body heading towards your collar bone area, where after multiple filtering, it drains back in to your blood stream. If cancer is found only in the lymph nodes immediately draining your prostate of lymph, that's likely to be more curable than if it's found further along the pathway, which is why staging identifies it as N1 when near the prostate, rather than distant lymph nodes which is identified as M1a as it's already leaked through many lymph nodes and further micro-mets are likely to have been established even if not yet found.


With radiotherapy of high risk cases, prophylactic treatment of pelvic lymph nodes is sometimes undertaken in higher risk cases even if it wasn't found in them, just in case micro-mets had already set up in there but not shown on scans. (One of the objectives of the PIVOTALboost trial is to see how effective this is at preventing spread which would otherwise have happened from micro-mets in lymph nodes.) Similarly with surgery, pelvic lymph node dissection (PLND) is sometimes included, hoping to go as far as taking all nodes with any mets in them, which you can only be reasonably sure of if you've gone as far as the first node in the chain with no mets in them. The trouble here is that may involve taking nodes which drain other areas such as groin and/or legs, leaving those areas with no lymph no drainage anymore, and lymphedema where water can't drain anymore, which is debilitating and not resolvable. (So I tend to suggest anyone going in to surgery with the expectation of extensive PLDN really considers radiotherapy to include pelvic lymph nodes instead, as that can cure cancer in the lymph nodes with a better prospect of leaving them still working afterwards.)


Interestingly, if you have a tattoo done, much of the ink will leak and be mopped up by the lymph system, and it tattoos the lymph nodes as it passes through them and they filter out the dyes. When bodies have been recovered from crime sites after attempts to prevent their identity, which often involves destroying identifying features such as tattoos, they have still be identified from the missing tattoos by finding matching coloured inks staining the relevant lymph nodes.



 


This is all amaxing to read Andy. My husband’s cancer has turned up in his lymph nodes after having brachytherapy 9 years aho. Weirdly no cancer in his prostate though. So it must’ve been hiding in the lymph nodes all this time (psa 0.01 for 5 years before increasing) I don’t know whether having no tumour to feed the cancer in the lymph nodes is a good thing, I hope so. 

User
Posted 13 Dec 2023 at 21:57
Some good stuff here. While seeming slightly off topic Andy's comments about tattoos illustrates the case. Black ("India") ink consists of carbon particles, you can think of them as markers for what would happen to cancer cells, Those free to move will get carried along with the rest of the fluid which has "leaked" into the spaces within tissues, and enter the lymph vessels which you can think of as like gutters or drains catching rainwater.

It is perhaps those lymph vessels that you can think of as like a highway (albeit a very slow highway) carrying fluid and its contents away - but only as far as the first lymph node. As LynEyre says those act a bit like colanders, except they also have a mechanism to attack rogue cells such as infectious agents or cancers. Cancer cells from the prostate need to overwhelm the capacity of the nearest lymph nodes for some of them to spread onwards through further lymph vessels to the lymph nodes more distant and ultimately other parts of the body. Even if there is no evidence from scans of spread, there is a logic in hitting the nearest lymph nodes with radiotherapy in case they contain cancer cells which could otherwise spread further.

It was fascinating to learn how lymph nodes can be investicated forensically in murders where efforts have been made to remove tattoos. Closer to normal experience, people might have noticed on others how finely drawn tattoos tend to "blur" and merge into an indistinct mess with time: that results from those ink particles moving away from the tattoo sites with the tissue fluid on their way to the lymph nodes.
User
Posted 14 Dec 2023 at 06:50



It is perhaps those lymph vessels that you can think of as like a highway (albeit a very slow highway) carrying fluid and its contents away - but only as far as the first lymph node. As LynEyre says those act a bit like colanders, except they also have a mechanism to attack rogue cells such as infectious agents or cancers. Cancer cells from the prostate need to overwhelm the capacity of the nearest lymph nodes for some of them to spread onwards through further lymph vessels to the lymph nodes more distant and ultimately other parts of the body. Even if there is no evidence from scans of spread, there is a logic in hitting the nearest lymph nodes with radiotherapy in case they contain cancer cells which could otherwise spread further.


 


JB my husbands original diagnosis said no spread into nodes, all contained in the prostate. All these years later psma scan shows no cancer in the prostate nor the nearest lymph nodes. It can be seen in nodes around the navel area and a few near his chest. They certainly haven’t invaded the nearest nodes in his case. I don’t know whether this is unusual or whether the psma scan can miss cells out. 

User
Posted 14 Dec 2023 at 07:50

Wiosal, my first PSMA scan lit up a right external illiac node. A few months later a second PSMA scan lit up a precaval lymph node. I am not a biologist but when I look at a diagram of the  lymph system,there seems to be alot of nodes in between that did not light up. There may of course be cancer cells in all those intermediate nodes that cannot be detected at the moment.


Thanks Chris 

User
Posted 14 Dec 2023 at 08:58

Originally Posted by: Online Community Member


Wiosal, my first PSMA scan lit up a right external illiac node. A few months later a second PSMA scan lit up a precaval lymph node. I am not a biologist but when I look at a diagram of the  lymph system,there seems to be alot of nodes in between that did not light up. There may of course be cancer cells in all those intermediate nodes that cannot be detected at the moment.


Thanks Chris 



I looked up your profile when you commented on my own thread. You are fortunate to have tried sabr on the nodes. We were hoping that would be an option for dh. But more nodes are involved than we originally thought. I still think it is weird that it isn’t in the prostate or surrounding nodes though, if his psa hadn’t gone so low for so many years I would think differently. But it was low for a long time. 
I can’t get my head round it really. 


 

User
Posted 14 Dec 2023 at 15:58

Lyn


Surely N0 relates to not being in the lymph nodes. I think your post suggests otherwise.


Thanks


Rory 

User
Posted 14 Dec 2023 at 21:17
Colwick Chris, Wiosal, you are right that lymph vessels are typically drawn in textbooks as running from node to node, so something would have had to go through the nearest nodes to get to ones further distant.

While that is believed to be the case, lymph vessels are mostly extremely small and almost impossible to see. The pictures are based on just a few careful studies using specialised techniques, and I don't think those definitely rule out the possibility of there being occasional vessels which bypass the nearest nodes.

In addition:
(1) all of us are different. While the descriptions may well be true for the majority of people as far as the scientists could tell that doesn't mean they are necessarily true for everyone and for you in particular.
(2) what makes a cancer establish a secondary in one place and not another is also poorly understood. It is possible most cells were stopped at the first lymph node they got to and destroyed without establishing a secondary there, but a few cells managed to pass beyond and succeeded in establishing a secondary at a more distant node.
User
Posted 15 Dec 2023 at 00:16

J B


The last point in your post is interesting. There is a lot of medical science in all this stuff but also a lot of luck.


Rory

User
Posted 15 Dec 2023 at 08:51

I can’t find the article again. But I read somewhere that cancer cells just in the lymph nodes alone don’t usually cause a problem, they need to work with the tumour. So I’m hoping that as dh doesn’t have a tumour in the prostate (yet!) that that is a good thing. The brachytherapy has killed it off. 

User
Posted 16 Dec 2023 at 00:51

Andy


As ever, insightful and helpful. They didn't do my lymph nodes despite being a Gleason 8, which fills me with a sense of dread that once my HT ends that I may have some bad news further down the road.


Thanks


Rory

User
Posted 18 Dec 2023 at 17:24

Hi Lyn


I was diagnosed with PSA 252  T3B N1 and had full pelvic radiation. 
I thought until now that N1 meant one pelvic lymph node.


The bone scan and the whole body scan were negative but because of the high PSA, I’m told I almost certainly have micro metastatic disease.


That was in February 2022.


What’s my life expectancy looking like?

User
Posted 18 Dec 2023 at 20:14

My diagnosis exactly the same , just completed my 20 doses of RT , think I may have a spot of skin cancer too now which needs investigating but would  not think it's linked to Prostate cancer .

User
Posted 23 Dec 2023 at 18:35

Originally Posted by: Online Community Member


Lyn


Surely N0 relates to not being in the lymph nodes. I think your post suggests otherwise.


Thanks


Rory 



Strictly speaking, N0 indicates that there are no mets in the lymph nodes. N1 indicates that there is cancer in the lymph nodes close to the prostate. M1a indicates that the cancer has metastasised to lymph nodes further afield. The problem is that we are seeing more and more commonly now that men with just one or two potentially affected nodes in the pelvis are being scored as N0 and offered treatment as if the nodes were not affected.   

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 23 Dec 2023 at 21:16

Originally Posted by: Online Community Member
The problem is that we are seeing more and more commonly now that men with just one or two potentially affected nodes in the pelvis are being scored as N0 and offered treatment as if the nodes were not affected.


Surely that's a big problem??!!


Jules

User
Posted 23 Dec 2023 at 21:49

Hi Lyn 


I was T3B N1 M0 and had full pelvic radiation, chemotherapy and hormone therapy.


That said, my PSA was 252 but the bone scan and full body scan were negative.


I was told there was a very significant risk of micro metastatic disease.


My report stated that only one lymph node was involved.


 

Edited by member 23 Dec 2023 at 21:50  | Reason: Not specified

User
Posted 23 Dec 2023 at 23:58

Originally Posted by: Online Community Member


Originally Posted by: Online Community Member
The problem is that we are seeing more and more commonly now that men with just one or two potentially affected nodes in the pelvis are being scored as N0 and offered treatment as if the nodes were not affected.


Surely that's a big problem??!!


Jules



I think that depends on your perspective, Jules. From an NHS resources point of view, it means that more men are being offered RP despite knowing that there is a significant chance of needing adjuvant or salvage RT whereas, in the past, they would have been advised to have RT / HT straight off. From the patient's point of view, it could be a good thing or a bad thing - the man might be thrilled to get RP and it is successful (or removing the bulk appears to slow down progression) OR the man may not understand the significant risk of recurrence and is devastated when the RP doesn't get rid of it. Based on what I have seen here over the years, the good / bad effect seems to depend an awful lot on whether the urologist explains the risk properly or glosses over it.  

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 24 Dec 2023 at 00:03

Originally Posted by: Online Community Member


Hi Lyn 


I was T3B N1 M0 and had full pelvic radiation, chemotherapy and hormone therapy.


That said, my PSA was 252 but the bone scan and full body scan were negative.


I was told there was a very significant risk of micro metastatic disease.


My report stated that only one lymph node was involved.



Hi Roger, there may have been only one lymph node showing as affected on the scans but,  as you will have realised, there is a possibility of micromets in many lymph nodes which may show themselves at some point in the future. That is pretty much what happened to Chris-J - the scans were clear for ages. I suppose it also matters whether your one lymph node was adjacent to the prostate or somewhere remote like under your armpit :-/   Either way, you have given it all barrels and will hopefully still be posting here in 10 years! 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 24 Dec 2023 at 00:07

My Oncologist certainly didn’t gloss over it! 
when I asked him what my life expectancy was in the chemotherapy room, he shouted at me in public, as in… “ How do you expect me to know that “ I thought he might have some idea based on previous experience.


 

User
Posted 24 Dec 2023 at 00:11

Thanks Lyn.


Do you know if a prostatectomy is cheaper [for the NHS] than RT/HT treatment?


Jules

User
Posted 24 Dec 2023 at 01:07

Originally Posted by: Online Community Member
he shouted at me in public, as in… “ How do you expect me to know that “


I'm sorry to hear that happened to you, it's totally outrageous.


Jules

User
Posted 24 Dec 2023 at 02:43

Who does ",we" refer to Lynn are you involved in medical research?


Thanks


Rory

User
Posted 24 Dec 2023 at 08:41

Originally Posted by: Online Community Member


Originally Posted by: Online Community Member


Originally Posted by: Online Community Member
The problem is that we are seeing more and more commonly now that men with just one or two potentially affected nodes in the pelvis are being scored as N0 and offered treatment as if the nodes were not affected.


Surely that's a big problem??!!


Jules



I think that depends on your perspective, Jules. From an NHS resources point of view, it means that more men are being offered RP despite knowing that there is a significant chance of needing adjuvant or salvage RT whereas, in the past, they would have been advised to have RT / HT straight off. From the patient's point of view, it could be a good thing or a bad thing - the man might be thrilled to get RP and it is successful (or removing the bulk appears to slow down progression) OR the man may not understand the significant risk of recurrence and is devastated when the RP doesn't get rid of it. Based on what I have seen here over the years, the good / bad effect seems to depend an awful lot on whether the urologist explains the risk properly or glosses over it.  



Lyn I am assuming dh must’ve had micromets. He was told he had 2 very small tumours all contained in the prostate. Nothing in the lymph nodes. It took 5 years for psa to start to rise after brachy and 9 years before it started to rise quickly. I’m sure dh must be unusual in the fact there are still no mets in the lymph nodes near the prostate and the brachy worked as nothing in the prostate either. 
How does it get to further nodes without being in the nearer nodes? Or is it just a case of they are too small to be picked by psma scan? Either way, I’m sure if he’d had his prostate removed we’d still be where we are now, unless he’d had nodes removed originally, maybe that would have worked. But we will never know that one. No point in thinking about it really. But I am interested to know how it got to further nodes and stayed quiet for all those years. 

User
Posted 24 Dec 2023 at 09:11

My lymph node was in the pelvis 

User
Posted 24 Dec 2023 at 11:22

I don’t know how many nodes dh has involved. They are in the navel area, which I’m assuming is still classed as pelvis, but none near the prostate. The paperwork also says a few lymph nodes in the posterior mediastinum. The consultant only said the lymph nodes were up near dh‘s belly button. But those ones are in his chest (according to google) 

User
Posted 24 Dec 2023 at 15:09

Originally Posted by: Online Community Member


Thanks Lyn.


Do you know if a prostatectomy is cheaper [for the NHS] than RT/HT treatment?


Jules



RT/HT used to be more expensive, but with increasing use of hypofractionation, that might not be the case anymore. I haven't seen any figures since well before COVID.


We were told that LDR Brachytherapy was the most expensive operation the hospital does, mainly because of the number of different consultants required in theatre during the procedure. (IIRC, it was urology, oncology, and medical physics.)

Edited by member 24 Dec 2023 at 15:14  | Reason: Not specified

User
Posted 24 Dec 2023 at 15:17

Originally Posted by: Online Community Member


 It was the most expensive operation the hospital does, mainly because of the number of different consultants required in theatre during the procedure. (IIRC, it was urology, oncology, and medical physics.)



It's December, so three wise men does seem appropriate.,

User
Posted 24 Dec 2023 at 17:05

I have just read your conversations about lymph nodes with interest. 


My original PSA was 82 and MRI score T3bN0 M0 and Gleason score of 4+5=9


I've just had my first appointment with the Oncologist on Thursday and he didn't fill me with much confidence. He said I probably would be on Hormone therapy for 2 years and start Radiotherapy in February consisting of 4 weeks treatment. My wife asked him what areas would he be targeting with the radiotherapy and he just said the Prostate and seminal vesicles. I followed this by saying seeing as its an aggressive form of cancer wouldn't it be best to include the lymph nodes? He had a think about it and agreed that's probably best!!


I also said what about doing a PET scan because nearly 3 months had passed since the original scans and the cancer could have spread. He said it would have been a good idea earlier but now that Hormone therapy had started it wasn't necessary. 


We made it aware that things have progressed slowly so far but now seem to moving on at a quicker pace. That was more or less it. Later in the day he called me and said he'd been reviewing my case again with a colleague and offered me a one off high doze of Brachytherapy at Christies in Manchester. I accepted this but thought he's only doing this because they haven't  given me the best care. 


The punch line is if we hadn't have pushed he wouldn't have included the lymph nodes in the radiotherapy.

User
Posted 25 Dec 2023 at 06:21

John


It seems to me that it's all a bit.of a lottery. I don't feel that I have had the best treatment. My lymph nodes have not been radiated, but that's just how it is. I have also noted that although my PSA is 0.34 after radiation and 12 months HT and the medics seem happy I cannot but note others down to levels significantly lower and often down from greater highs. 


What can one do, not a lot other than enjoy each day. I love the positivity of all those who heroically declare that their cancer won't define them. My cancer may not have defined me but it has certainly changed my life. Happy Christmas ⛄.


Rory

User
Posted 25 Dec 2023 at 09:10
Thanks Rory. I love your positivity.
Merry Xmas to all on this site.
PS
I thing I forgot to mention is that the Consultant said they don't have a PET scanner at Preston Hospital. I'm sure I've passed one on the way to the MRI scan. I can't believe a city like Preston doesn't have one.
User
Posted 25 Dec 2023 at 11:36

John


My hospital didn't have a PSMA scan either, but on a positive note Preston have a great football team and I am half way through a bottle of Barolo. All we need now is Allaho to win the King George at Kempton tomorrow!


Rory

Edited by member 25 Dec 2023 at 12:13  | Reason: Not specified

User
Posted 25 Dec 2023 at 15:58

I support Rotherham United so I'm really depressed 😂

User
Posted 25 Dec 2023 at 16:00

Rotherham hmmmm now that's another story. Happy Xmas.

User
Posted 26 Dec 2023 at 13:25

Reading don't have one either. They send patients to Oxford or Mount Vernon for PET scans.


However, hospitals without their own PET scanner offer far fewer PET scans to their patients. I had assumed this might down to cost, but an oncologist said to me it's also familiarity - oncologists in centres without PET scanners are less experienced in using them, often don't realise how useful they are (some have even been skeptical), and how often they cause in changes to treatment which improve outcomes.


There is a big shortage of PET scanning capacity though. This is causing a waiting period which is itself unsuitable for some patients, resulting in treatment having to go ahead without waiting for a scan.

User
Posted 26 Dec 2023 at 14:15
Following RP and RT ten years ago. They have detected a 4mm lesion in a pelvic lymph node with a PSMA scan. They did not discover anything else apart from some OA. The prostate bed was clear. Does this mean the PCa has been lurking in that lymph node for years. I am now waiting for for an appointment in January to see if SABr treatment is possible/appropriate

Thanks
Bri
User
Posted 26 Dec 2023 at 14:58

Originally Posted by: Online Community Member
Following RP and RT ten years ago. They have detected a 4mm lesion in a pelvic lymph node with a PSMA scan. They did not discover anything else apart from some OA. The prostate bed was clear. Does this mean the PCa has been lurking in that lymph node for years. I am now waiting for for an appointment in January to see if SABr treatment is possible/appropriate

Thanks
Bri


You sound similar to dh with it in a lymph node. Though dh has it in more than one lymph node. However it is 9 years from original treatment and the original treatment worked as nothing found in the prostate. It’s amazing it can sit in the lymph nodes all that time without putting out psa (dh’s psa was 0.01 for almost 5 years) As I said above I don’t get how it got into nodes further up into the pelvis, but none in the nodes close to the prostate. The consultant did say they must’ve been there all along. In that case….its annoying they don’t just do a psma at initial diagnosis. 

User
Posted 15 Mar 2024 at 12:58

I was diagnosed with Prostate cancer in February 2022, T3B N1 M0. Gleason 8,PSA 252.


 


I’ve had 6 chemotherapy sessions and 37 radiotherapy sessions. I’m also on hormone therapy.


 


First PSA test after completion of treatment 2.1


 


Second test four months later 0.5


 


Third test 0.2


 


My fourth test is in March


 


The March results have just come in at less than 0.1 which is quite a relief.


 


The real issue is what happens to the PSA in years time when I come off ADT.


 


Given what I presented with,I’m not holding out much hope but at least I am okay for now.


 


I thought I would post an update, if it’s of any interest to anyone.


 

User
Posted 15 Mar 2024 at 16:53

Andy is one incredibly smart and helpful person along with a few others on here that have helped me and many others in dark times carry on with this disease i personally can't thank you all enough for all your help and support you know who you all are thanks again garry 👍

 
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