The majority of people I have heard from that had prostatectomy did not have lymph nodes removed unless it had spread. None were removed in my case.

I suspect if you’re Gleason eight or nine, there’s a lot higher chance of them wanting to do that As precautionary measures.

I think they make the decision based on how aggressive they believe the cancer to be. The pelvic lymph nodes are a very common place for the early spreading to show up. The imaging scans aren’t nearly as reliable as actually examining the nodes themselves under a microscope.

My husband was similar to you in that he had Gleason 4+4: 8, MRI showing no spread, and PSMA PET showing no spread. However he did have 2 extracapsilar extensions on the left. His surgeon is the head of the urology dept at Mayo - Jacksonville, FL. We lucked into him when he got a cancellation. When we met with him the day before surgery, he said he would take up to 10 on each side, to ensure that no spread to lymph nodes because PSMA PET was a month ago and MRI (an updated done last week) is not always 100%. Because my husband has a PSA of 24.5 plus Gleason 8, it puts him in the very high risk and an aggressive form. Surgeon said with aggressive cancers, they lean toward lymph node dissection (while they are in there) to ensure no spread. We’re dealing with all the aftermath right now but we both will feel so much better when path report comes back negative.

**Addition: My husband had bilateral mesh hernia repair by a dr who “used more mesh than I’ve ever seen” (dr.’s quote) and that made it difficult to get as many lymph nodes from the left/affected side as he wanted.