Decision on removing lymph nodes during Ralp procedure

They took some from each side of me during surgery. I thought it was SOP to check for spread. No problems that I am aware of 4 years later.

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!

My surgeon didn't give me an option. He just straight up told me that he would be taking some lymph nodes to test them. My surgery notes just say "an unknown number" were taken and the histology was done on all of them. My suggestion is have some removed so that they can test them. My path report came back clean for spread hope yours will as well.

Prior to surgery, PSA WAS 29 and Gleason was 3+4. I was 64. PSMA had only recently been approved by FDA and was not commonly used presurgically. During surgery, seven lymph nodes were removed. Two were positive for cancer. Several weeks after surgery, PSA was around 5, so I was given a PSMA scan and an additional lymph node lit up and had to be removed. Several weeks after that, I still had a detectable PSA. The doctors were not in agreement about next steps, and I went to MSK for a second opinion. Doctor there did say that they would have removed more lymph nodes in my situation. In any case, I underwent two years of ADT and 47 EBRT sessions. I am now nearly two years out from finishing therapy and am undetectable so far. Side effects from both surgeries were typical—swelling, some pain, constipation, urinary incontinence, etc. but none of it unmanageable. Wishing you all the best.

Prior to surgery, PSA WAS 29 and Gleason was 3+4. I was 64. PSMA had only recently been approved by FDA and was not commonly used presurgically. During surgery, seven lymph nodes were removed. Two were positive for cancer. Several weeks after surgery, PSA was around 5, so I was given a PSMA scan and an additional lymph node lit up and had to be removed. Several weeks after that, I still had a detectable PSA. The doctors were not in agreement about next steps, and I went to MSK for a second opinion. Doctor there did say that they would have removed more lymph nodes in my situation. In any case, I underwent two years of ADT and 47 EBRT sessions. I am now nearly two years out from finishing therapy and am undetectable so far. Side effects from both surgeries were typical—swelling, some pain, constipation, urinary incontinence, etc. but none of it unmanageable. Wishing you all the best.