When discussing what was then my "pending" DaVinci Robotic-assisted Radical Prostatectomy, I asked my urologist if he planned on removing my lymph nodes as well? I knew that if the cancer spreads to the lymph nodes, your time is now limited. My urologist had two responses: 1) Statistical studies show that after many lymph nodes being removed, and an overwhelmingly vast percentage in the upper 90-percents showing no-invasion/no- pathology, standards of practice for prostatectomy now do NOT routinely remove the lymph nodes. He added that the prevailing and accepted protocol is to NOT remove lymph nodes, as is offered by the author of the above Mayo post. 2) He told me that with my Gleason score of 3+4=7 (with only 6-10% of cells "4" on the second pass examination), a PSA of 6.1 ng/ml, and most importantly, a PET Scan that showed 100% confinement of the cancer in my prostate, that he "didn't need to remove the lymph nodes." Had there been Gallium-68 radioactive tracer uptake outside the prostate, and perhaps specifically in the lymph nodes, he would have removed them, but that he and the general population just don't see it very often.
I was however reminded of the father of my sister's best friend. "After" he died of prostate cancer in his late '60's, his family and friends recalled how he was often complaining of lower back pain for a very long time. He thought he was just getting old and was "paying for" all of the misuse and strain on his back through his earlier years. He was finally diagnosed with prostate cancer, and was dead within a few months after, with massive pelvic area lymph node invasion, as well as elsewhere in his body. I don't recall what his Gleason score was, but it was likely a 5+4=9. Lesson learned for men over 40 to 50 and onward: If you have lower back pain - and really for no reason - and you haven't had a PSA in a while: Go to the doctor and get tested before it is too late.