Prostate Surgery With Bilateral Lymph node dissection

Did the pet test see cancer in a lymph node, Or at least it was iffy whether there was cancer.

Were they also going to do a prostatectomy at the same time? That is often what they do when they remove lymph nodes. They don’t usually remove many in that situation.

I’m a little puzzled as to what direction they are going for you when you only have one core and it’s a 3+4.

Have you considered going for a second opinion? It sounds like you need more information.

Oh boy, here we go again- one of the lymph nodes on PSMA was iffy but surgeon insisted "he is not convinced". We asked again before surgery if it would be prudent to take some nodes out and examine them and we were told after surgery that "they all looked normal size, so there was no need" . I guess some doctors have innate x-ray vision 😵‍💫. I am 100 % sure now after pathology report came as it is that "low glow node" was positive. This is really becoming medical negligence case, IMHO.

Thank you so much for sharing your husband's experience with lymph node removal. With every response like yours, my anxiety level is going down, and I should be able to follow my Urologist's recommendations with much reduced concern.

Unfortunately, some aspects of prostate surgery do not have a 100% black and white guidelines and depend on the urlogist's risk assessment, experiece etc. And some urologists may not keep up with all the new guidliness or may be negligent. In my own experience one of the urlogists I consulted for second opinion decided I should be on active surveillance even before my pathology report was re-read, and while the GPS test score was pending!! He said that even if the new re-read of the pathology comes out to be 4+3 instead of 3+4, I should be on active surveillance! I am not a urologist, but what this doctor told me is 100% BS (a new medical term :)) ! It does not align at all with the NCCN guideline on treatiment for unfavorable intermediate risk patients. I never saw that dude again!!

3+4 is better that 4+3, and one core out of 18 is good, but I have two very high risk factors.
First is my PSA is 14.5. Second risk factor: a GPS score based on DNA test was 47. That is very high with less than 20 being very low risk , 20 to 40 being intermediate risk , and anything above 40 being very high risk of having a very aggressive form of cancer. That nailed if for me to seek definitive treatment. If my GPS score was less than 20, I would definitley have considered active surveillance.

Yes, the plan is to remove the lymph nodes with the prostatectomy.

I noticed that once our case was moved from our local urologists to the specialists at ucla the experience was quite different. The urologists were indeed very nice and competent dudes and they did their jobs well. They did especially well in passing us on to our new docs at ucla. 😊

UCLA medical is one of the best, so you are in good hands.

I agree.

I believe they punched my biopsy 3+4 numbers into a nomogram and used the result to decide if lymph nodes should be removed. I was very confident in my doctor and trusted his judgement. I didn't really ask but believe node removal, for my case, was mostly diagnostic for staging. Thankfully, all 13 were negative. I had confirmed cancer in my prostate and it looked contained from the MRI images. Didn't have a PSMA pet scan. I did do a Prolaris test it indicated that I was on the borderline for treat or active surviellance. Looks like the biopsy missed the bad stuff because
my surgical pathology gleason grade was upgraded to 4+3, tertiery 5, cribriform, PNI. The margins were negative and so were the 13 nodes. I've been < .1 for 22 months. I was never incontinent but it took about 7-8 months for erections with the help of viagra. I hate cialis and viagra but still need it to this day.