Connect
← Return to With regional lymph node metastasis what is the progression?
Discussion
With regional lymph node metastasis what is the progression?
Prostate Cancer | Last Active: Jul 14 7:30pm | Replies (22)Comment receiving replies
Thanks to all.
Both my Oncologist and Surgeon told me that the cancer had probably metastasized to the lymph nodes, although they could not be certain. That the cancer is oligometastatic, and its progression well documented in research. Each doctor has decades of experience treating prostate cancer, and I am comfortable with their assessment. It seems to follow from everything I have read.
My reason for chatting here was not that I was concerned about a 0.02 PSA value. Additionally, I am only somewhat concerned about a metastatic diagnosis. Not sure where anyone even got those ideas from. I have my ideas about that, but don't need to share those here.
My concern has always been with coming to a deeper and broader understanding of my diagnosis so that I can make better treatment decisions with my doctors.
This is one of the main points I took away from @kujhawk1978's (Hawk) post. I found those comments very helpful, and at the same time caring. All of my questions, and a bit more, were answered there. So, thank you Hawk!
I found that @jeffmarc (Jeff) posts did not add much depth to the conversation except for some unneeded editorialization. This was disappointing since he obviously knows a lot. Still, the content was helpful, if not a bit aggrandizing and sprinkled with hubris. So, thank you as well Jeff!
Check out "Treating Lymph Node #ProstateCancer Metastases | #MarkScholzMD #AlexScholz #PCRI " on YouTube.
I hope all the best in our journey down this shared road!
Replies to "Thanks to all. Both my Oncologist and Surgeon told me that the cancer had probably metastasized..."
There is light at the end of the tunnel...
One of the dilemmas in our decisions to treat or not is the evolving landscape of treatment and imaging brought about through medical research.
When I was diagnosed in January 2014, the treatment choices were binary - surgery or brachytherapy. Imaging choices were single, CT and MRI, really not effective until PSA 20 or greater, of no use to me, diagnosed with a PSA < 3. Today, insurance companies aside, we can and do employ PSMA PET in the initial diagnosis,
Today we have a plethora of choices. The landscape and philosophy have changed, rather than monotherapy, each destined to fail with a certain end, now we combine treatments and bring them forward in our cancer to "overwhelm" it in its early stages.
Today we have a choice of which ADT agent, which radiation machine, we know that no, ARIs are not all alike, that while chemotherapy may be used early in recurrent PCa, the benefit may be in high versus low volume, genomic testing and profiling may be useful in individualizing treatment decisions, we have radioisotopes, PARP inhibitors....
It may be that when the next time my medical team and I sit down to discuss treatment, ADT may not be on the menu! Intriguing...!
With this plethora of choices comes the possibility of paralysis by analysis, what is the right decision...? I argue there is not a right decision, there are good decisions based on the science - the NCCN, AUA guidelines, data emerging from clinical trials and our individualized preferences balancing quality and quantity in our lives:
This about sums it up for me - while living longer is an important goal, many patients also prioritize:
• Controlling PSA levels.
• Avoiding treatment-related side effects.
• Minimizing pain and functional limitations.
• Maintaining independence.
• Supporting their families
• Preserving overall quality of life.
Did you have a CT scan or an MRI That showed your cancer has spread to the lymph nodes? You haven’t mentioned it in any of your messages.
I’ve never heard of a doctor hypothecating that Lymph nodes have cancer spread without some sort of proof. Your six months of unchanged PSA, without drugs (You never said you were on any cancer drugs) seems to belie any suggestion you have cancer in lymph nodes. Why isn’t it increasing your PSA if you already have spread.
Something is wrong with this picture!!!
Connect
I am very early down this road, and Jeff is probably the most experienced among us, but from what I'm viewing and reading it seems that even the most aggressive oncologists don't act until the PSA has risen to at least .1 and some not until it reaches 1 or 2. For me, ADT is a severe treatment, taking Orgovyx and experiencing every listed side effect, but for some the issues are far less. During the spring when I was receiving both radiation and ADT, I came to the point of nearly quitting and my wife was supportive because of what she observed. I have felt some better since completing radiation, but unless I exercise regularly and vigorously I have no energy. At 73, I'm really concerned about quality of life and a bit less so about longevity, so I'm hoping to end ADT earlier than my prescribed 24 months. May your journey go well!