My husband had a Gleason 4+5 after the biopsy. His surgeon removed 15 lymph nodes, more at the side of the tumor. He got a large lymphocele after the surgery, especially on this side. It took many, many weeks to dissolve, but thank god it finally did. We were worried that it would develop into a permanent lymphedema. That may happen from a lymphocele when lymph nodes have been removed. It hasn't happened, at least up to now, but if my husband is really unlucky, it may still do so.

The surgeon doesn't remove a specific number of lymph nodes, he does not even remove the lymph nodes per se. They remove some tissue from which the pathologists extract a number of lymph nodes later. If I understood it correctly, they do not know before how many there will be in. They find more (as in my husband's case) or less. It seems also that the total number of lymph nodes one has varies significantly.

In my layman's understanding, the problem is not only that a few lymph nodes are missing, but also or even more that damage that is done to the lymph vessels and the surrounding tissue by cutting them out. Most people have no side effects or little swelling only. It clearlay depends also on the extent of the dissection. However, the side effects of an ectomy are much more grave than radiating lymph nodes.

They take them mainly out for diagnostic purposes as we have understood. With the availability of PSMA-PET Scans and ultra-sensitive PSA testing, there may be less need for extensive and distant lymphadectomy. In former times they must have taken out many more nodes than today, we were told! There may be cases in which the cancer had spread to an extracted lymph node and not yet further. Then the lymphadectomy has cleary an advantage. But as others have written, there are pros and cons. If the spread is rather unlikely, I don't know... Unfortunately, I cannot give you any good advice. If I was in the decision situation again, I would ask our doctors whether removing the prostate and radiating well targeted a few lymph nodes would make any sense. (Probably not) All the best!