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← Return to thoughts on what I should do.
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For context in this discussion, but also for those of us who are not yet years out from our surgery, would you share your age when you got RARP, the Gleason at the time, the post-op pathology or any other information that might help us understand how prostate cancer progressed past the initial treatment?
I'm particularly interested in this because I lost no lymph nodes as the surgeon found no cancer in them - but I did have a bulge that could be problematic for me down the road.
Replies to "For context in this discussion, but also for those of us who are not yet years..."
I honestly don’t think a surgeon can “see” cancer in a lymph node or not- which is why most of the centers of excellence recommend removing at least six on each side.
Imagine them on a string running from your prostate and down toward the pelvis.
The pathologist examines them sequentially, first to last; if he sees cancer microscopically in the first, he then looks for it in the second and then down the line and so on until he hopefully finds none. If he does find cells then you are usually put on ADT and offered salvage therapy or surveillance.
Not removing a larger number of lymph glands is controversial. My surgeon, for instance, only removed the closest one to the gland ( I believe it was called the “bullseye node” in the path report) and I learned later that he was sued by some patients for doing just that.
Man, was I pissed!! But after going on various forums I discovered that a lot of surgeons do this for one reason or another.
I don’t agree with it or like it, but I am not a cancer surgeon so who am I to say?
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In the end, I think the choice is just informed guesswork. As I've mentioned before
1. If the cancer is still contained entirely inside the prostate, a prostatectomy will eliminate it permanently, often without damage to surrounding organs, but ...
2. ... if some cancer cells have already escaped, then a prostatectomy will miss them, while radiation (which continues to spread for a few weeks after therapy finishes) has a good chance of catching them if they're still lurking in the vicinity, but also ...
3. ... because radiation keeps spreading a bit, there's a risk of damage to your bladder and rectum (and also a chance that the radiation will catch any yet-undetected cancer cells there before they multiply and make new tumours).
There's no way to be sure if the cancer is all still in the prostate — there's no test yet that can detect individual cancer cells — so it's about balance of probabilities: e.g. a low Gleason score and no risky genetic mutations give you a better chance that it's all still in your prostate (but there's never a guarantee).