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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2005Lymph nodes
I have scheduled my robotic LRP for April. My doctor called me today to ask if I had any questions about the surgery or his results and I asked him if he removes the lymph nodes or not since I am stage T1c,G6,PSA 7.4, age 60. He said he always removes the nodes since it not only assures him that he has removed any cancer,but is also uncomplicates the surgery. My question is: Is it standard practice to remove the nodes and is there any risk or complication in him doing so? He did say that if a patient asks him to not remove the lymph that he wouldn't. Looking at the Partin tables it looks that the chances ,at my stage and PSA scores and Gleason scores, of the cancer being present in the lymph nodes are 0%. Do they remove the nodes in the open RRP? He also said that he has a priority list of 7 things when he operated on a patient. #1 thru #5 was get rid of the cancer, #6 was continency, and # 7 was potency. I suppose most of the surgeons that operate on PCa feel this way, as they should. Any comments would be appreciated since #6 and #7 are always on your mind when you think of surgery. Yelnats > He also said that he has a priority > list of 7 things when he operated on a patient. #1 thru #5 was get rid of > the cancer, #6 was continency, and # 7 was potency. I suppose most of the > surgeons that operate on PCa feel this way, as they should. Any comments > would be appreciated since #6 and #7 are always on your mind when you > think of surgery. Yelnats When the urology surgeon who did my diagnosis started talking like this, I looked for another surgeon. (It mattered how he said it, too. I went to one who did a lot more of the RP procedures each year, and who had the balls to brag on his web site about his success rate on #7.) I was T1c, G7, PSA 4.79, age 53. I had lots of problems with #7 the first year, but have healed pretty well since then. I'm now 3+ years post surgery. No problems at all on #6, and no known problems on #1 through #5, for all of which I'm grateful. JohnG doing the LRP - that is the one big drawback of having that particular type of surgery and that is how this particular surgeon is insuring that he's not leaving anything behind. it is like an overkill in the sense that it may not have to be done, but he can't take that chance due to the LRP. on the RRP, the surgeon has the opportunity to physical touch and feel for cancer in the lymph nodes, but it takes longer to heal. so, there you are. the good and the bad. chances of incontinence and impotence are about the same for either. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc They took lymph nodes only from one side for me because of complications with the mesh from earlier hernia repair on the other side. Mine was conventional surgery. No side effects that I know of. To be honest this is the first time I have heard anyone question the removal of the lymph nodes. I never though before to question exactly what they do, why are they there, and what happens when they are gone? Good question. > I have scheduled my robotic LRP for April. My doctor called me today to > ask if I had any questions about the surgery or his results and I asked [quoted text clipped - 3 lines] > question is: Is it standard practice to remove the nodes and is there any > risk or complication in him doing so? <snip> It's been nearly a couple of years since I looked into this (LRP not robotic on 7/15/03)but I am under the impression that the only reason to remove the lymph nodes is to see if there is any cancer in them, and if there is to terminate the surgery early since removal of the prostate is pointless with the cancer already spread. With low numbers such as yours many surgeons would not bother with the lymph nodes nor with pre-surgery bone scans and the like. I don't see why there would be any difference with RRP or LRP in this regard. Taking out the lymph nodes to make sure "nothing is left behind" is moot. Clear lymph nodes means the prostate is yanked, cancer in the lymph nodes means the prostate should have been yanked months or years ealier. The only possible gain is if the cancer has spread you can keep the prostate and avoid some of the side effects of surgery while on hormone therapy. No big prize there. Some docs need to make a car payment so a bone scan or two can help in that way. I don't know if they can charge extra for the lymph nodes. Dave Perry Thanks for the replies. I notied in Walsh's book that, in most men, he removes the lymph nodes as part of the operation (page 223) and has them biopsied along with the prostate. I guess they used to do a frozen section but that procedure could miss a piece of cancer. I know they only remove the pelvic nodes and not the groin or inguinal nodes. Some doctors do not remove the nodes with men in early stage cancer since the likelihood that the nodes have been invaded are unlikely. But, with PCa it seems you're never 100% about anything, so it seems unreasonable to "play the odds" about removal of the nodes as long as the SE are nil. Just wasn't sure if this was "standard procedure". What did the surgeons that operated on all of you do? Yelnats > Thanks for the replies. I notied in Walsh's book that, in most men, he > removes the lymph nodes as part of the operation (page 223) and has them [quoted text clipped - 7 lines] > this was "standard procedure". What did the surgeons that operated on all > of you do? Yelnats I had RP and was told they yank them since it's a trivial exercise. I was DXex as 3+4=7 PSA 5.94. I've not heard of removing "the" lymph nodes. During RRPs, docs often remove a node or two and have them biopsied before proceding with the surgery. The thought is (was) that if there is cancer already in the lymph nodes, then it's already too late to take out the prostate. More recently, some have decided taking out the prostate still gets rid of a mass of cancer, so they go ahead and do it. One of the problems with LRP used to be asserted was that lymph nodes could not be removed and biopsied. I don't think that's true.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 Seminal Vesicle involvement, Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05 PSA .07 .05 .06 .05 non Illegitimi carborundum > I have scheduled my robotic LRP for April. My doctor called me today to > ask if I had any questions about the surgery or his results and I asked [quoted text clipped - 12 lines] > would be appreciated since #6 and #7 are always on your mind when you > think of surgery. Yelnats Chris had them removed and immediately biopsied with similar numbers. Head of Urology at U of Washington does it as a matter of course. SignatureRebecca Ford >I have scheduled my robotic LRP for April. My doctor called me today to > ask if I had any questions about the surgery or his results and I asked [quoted text clipped - 12 lines] > would be appreciated since #6 and #7 are always on your mind when you > think of surgery. Yelnats
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