Prostate cancer of the right common iliac medial artery lymph nodes

Hi, I have also a recurrence in the right common illiac lymph node after RP in 2019.
My doctor says this is oligometastasis, beyond local recurrence but not distant mets.
How are they proposing to treat you? They are suggesting to me I might benefit from surgery, removal of the lymph nodes and this may delay the start of radiotherapy and hormone treatment, although I'm not convinced this is the best option.
I would appreciate hearing what your team are suggesting for you.
Best regards

Thanks for replying,
I was diagnosed with stage 3 prostate cancer back in late 2017. PSA 30 and Gleason scores of 7s, 8s and one 9. My treatment was hormone, RT, and high dose Brachytherapy.

The reoccurrance was detected 2 months ago via PSA. My doubling time was 1.6 months. 7 months ago nothing then bang here I am. They did a PSMA/Pet and found two of the Iliac common artery nodes had an SUV of 80 and 88.

So my urologist started me on hormone treatment 2 weeks ago, and I am scheduled scheduled with my radiation oncologist to go in for my RT simulation Thursday.

Only thing that might get in the way of the RT treatment is what was the amount and exact location the the previous RT I received. He was waiting the the data to be sent to him from my previous oncologist. Hopefully I didn't get to many rads before.

I would be cautious of the surgery recommendation. My medical team, urologist, oncologist and radiologist have not recommended it either time I've had reoccurrence in the PLNs based on imaging.

The first time my radiologist treated the entire PLN system, 25 IMRT, 45 Gya. The 2nd time she is using SBRT, five treatments.

With the first reoccurrence we added taxotere and ADT, Lupron. This time we're adding Orgovyx and Zytiga to deal with micro metastatic disease, too small to be seen by imaging.

Here's a link to an article about PLN radiation treatment - https://www.prostatecancer.news/2021/05/new-guidelines-for-salvage-radiation.html

Kevin

Hi Kevin,
Thanks so much for your reply, your answer to my dilemma has been very helpful, I will not go ahead with the surgery as there are to many unknowns.
I have the possibility to enter into a clinical trial (Primordium) RT with ADT and apalutamide.
It is has the benefits of being in a very good private hospital ,close monitoring,all following pet/psma scans also included (my insurance doesn't have the required cover) I may get the trial drug or maybe not, 66/34 possibility in favour, even if I don't get the additional drug I will get RT,ADT in a top private hospital. They suggested 20 sessions 53-60 gy for pet positive node and prostate bed, and 20 sessions to pelvis 48 gy.
with 6 months decapeptyl preceded by 10-14 days casodex.
The alternative is to have the treatment on the social welfare.
They recommend
RT pelvis 50gy at 2.00gy/fr
+SIB prostate bed 62.5 gy at 2.5 Gy/fr sequentially SBRT on the infected pet+ node at 33 gy in 3 fractions.
6 months eligard but with no additional meds to stop testosterone flare.
I Will have to make a choice soon
Again thanks for your input,I realise everyone's journey is different but it's very insightful to see how the medical recommendations and treatments in different countries compare to my own.
Stay well
Best regards Andrew

Andrew. I am on this Jansen clinical trial with ADT & Apalutimide ( Erleada ) 6 months meds, then RP, then 6 months meds. It was manageable for me and I got good results. The Erleada has a side effect of increase blood pressure which is not a side effect of the ADT and I was delighted to get this side effect as it indicated that I got the Erleada. As I recall, men in this trial who got the Erleada averaged 41 months before the cancer progressed while men who got just ADT averaged 17 months. I am glad that I took my surgeon’s urging and accepted the clinical trial. Good Luck to all.

bandsaw, Can I ask how this turned out? Thanks. J

I am 40 months since beginning the clinical trial and my PSA is still undetectable and my testosterone is 109. That is a good result as my surgeon advised 40 months ago that my PC was Gleason9, locally advanced, aggressive, incurable and a life expectancy of 4-5 years. I am thinking and hoping that my doctor is too conservative on life expectancy. I am feeling great and hoping for the best for me and all of the guys here!

All I’ve ever heard from many men in your situation is the standard “4-5 yr” prognosis. Most are still going strong…

Not so good, recurrence again. Psa is raising fast, psadt 1.6 months.
Going in for another PSMA-PET again to see where it has spread. Also, greasing the skids to get ready for Provenge treatment.

Hi Bandsaw, I saw your post and immediately looked up anatomy charts of lymphatic system. I had the laser HoLEP procedure in May of last year. With this procedure, the capsule wherein the prostate rests is left intact.
Thus we have the proverbial "orange rind without any orange in it." Six months after my procedure, my PSA was 0.811. I then went to an independent lab a few months later and it went down to 0.83. I must presume that this reading is caused by the "capsule" as well as other nerves spared, which by the way, still produce pre-semen fluid.
It is possible however that he didn't remove the entire prostate- he said he did, but I don't believe him.
During my one year and nine months WAIT with a urethral catheter, changed every two months, I had been having a dull pain in the lumbar (I also have three disk protrusions from an accident 30 years ago), and pain around the sacral srea. Since the HoLEP, the pain has persisted. It is to the point that it has become difficult to stand erect from a bending position rapidly because of the pain. The pain is now on what would be considered the region where those artery lymph nodes are because they are deep, below the bladder floor, behind the bladder and to the left and right. This is not a muscular issue, in my opinion. I had suspected bone, however the pain seems to be "referring" from the areas where your recurrence has been detected. I have repeatedly mentioned this to my GP and to the surgeon. In fact, my last visit which was my first, six months after surgery, he mentioned that my PSA number wasn't significant, yet alarmed when I mention "bone pain" which at the time I had thought it was. What does he do? About 15 minutes after I left his office, I receive an SMS message on my phone with a link to a prostate cancer support group at that hospital. I believe he thinks he's dealing with a moron.
QUESTION:
Are you experiencing pain? If so, for how long? How long before & after your procedure? Did you feel it was a "muscular issue" or coming from the bone? Please answer as soon as you can and thank you for your post. Although, I suppose empathy is probably all you can tolerate right now, I am sorry you got this news and I hope you find a way around surgical options.
Best,
Del