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Decision on removing lymph nodes during Ralp procedure

Posted by payner @payner, Aug 10 5:31pm

I'm a 66-year-old with a Gleason score of 3 + 4 = 7 Grade and a high decipher score of 95 %, indicating more aggressive cancer cells. The cancer has not moved outside of my prostate. I will be having RALP on Sept 8th and need to decide on removing lymph nodes or leaving them in.
My doctor believes they are probably healthy lymph nodes, but is offering to remove or leave them. A decision I still need to make with him. He has done over 2,000 surgeries and not had any issues with lymphadenectomy.
I would appreciate hearing from anyone in a similar situation and how they made their decision.
I would also like to know if anyone had a RALP and had to have salvage surgery on their lymph nodes afterward due to an increase in PSA.
Please share any experience or recommendations, as I greatly appreciate comments. Thank you!

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keywest19 | @keywest19 | 5 days ago
In reply to @cath57 "My husband had a Gleason 4+5 after the biopsy. His surgeon removed 15 lymph nodes, more..." + (show)
Profile picture for cath57 @cath57

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!

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@cath57 great explanation. I had 13 removed and always wondered why that number

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prowler6b | @prowler6b | 4 days ago

I had surgery in 2013 with seven nodes removed. The surgeon never gave me an option as I remember. Following the surgery the incision at the umbilicus where docking station is inserted opened. This resulted in a deep hole that became infected and required months of healing from the bottom up.
A CT scan conducted afterwards to insure the infection was gone indicated a huge mass in my pelvic cavity that was thought to be cancer. This was later determined to be a multi chambered lymphocele. One and one half liters in size.
At this same time I had a cracked tooth that needed to be extracted and I told my oral surgeon about the lymphocele issues. However, he extracted the tooth without prophylaxis antibiotics. One week later the lymphocele was infected with streptococcus bacteria and I required open surgery to remove the infected lymphocele.
All this infections and surgeries resulted in a huge abdominal hernia and another major surgery to repair the hernia. I developed a pulmonary embolism ass I result of the hernia surgery and am quite lucky to be writing this narrative!

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chippydoo | @chippydoo | 4 days ago

Even if they take a bunch of nodes out and don't find a positive one you can still have a reoccurrence. Surgeon took a bunch of mine but yet I never went undetectable lowest being 0.03. PC cancer can leak into the Prostate bed requiring salvage radiation. Mine was considered a margin not a node.

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heavyphil | @heavyphil | 3 days ago
In reply to @chippydoo "Even if they take a bunch of nodes out and don't find a positive one you..." + (show)
Profile picture for chippydoo @chippydoo

Even if they take a bunch of nodes out and don't find a positive one you can still have a reoccurrence. Surgeon took a bunch of mine but yet I never went undetectable lowest being 0.03. PC cancer can leak into the Prostate bed requiring salvage radiation. Mine was considered a margin not a node.

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@chippydoo I agree…having seen some videos of this ‘bagging’ of the prostate before removal, it doesn’t seem very exacting and far from perfect.
There seems to be a fairly high chance for spillage, right? There’s no reason why these clumps of cells can’t reattach and regrow.
Years ago a friend had an aggressive colon cancer; after tumor removal she was reclined on the table (almost upside down) and her insides were repeatedly flushed with sterile saline to be sure no cells remained.
Makes me wonder if the 30% or so cases of recurrence after RARP are caused by the zeal to be ‘non-invasive’…
I would love to know what the numbers for recurrence were when ‘open’ surgery was performed. It’s probably out there somewhere…🤔
Phil

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2 replies
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chippydoo | @chippydoo | 3 days ago
In reply to @heavyphil "@chippydoo I agree…having seen some videos of this ‘bagging’ of the prostate before removal, it doesn’t..." + (show)
Profile picture for heavyphil @heavyphil

@chippydoo I agree…having seen some videos of this ‘bagging’ of the prostate before removal, it doesn’t seem very exacting and far from perfect.
There seems to be a fairly high chance for spillage, right? There’s no reason why these clumps of cells can’t reattach and regrow.
Years ago a friend had an aggressive colon cancer; after tumor removal she was reclined on the table (almost upside down) and her insides were repeatedly flushed with sterile saline to be sure no cells remained.
Makes me wonder if the 30% or so cases of recurrence after RARP are caused by the zeal to be ‘non-invasive’…
I would love to know what the numbers for recurrence were when ‘open’ surgery was performed. It’s probably out there somewhere…🤔
Phil

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@heavyphil I have to agree with you on this and have wondered myself. Doubt we would ever get a doctor to admit it much less discuss the percentage of it happening. Leaking prior to surgery also makes sense. Collapsing crib structure might be one of the causes. But I don't know anything lol.

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payner | @payner | 3 days ago

Well said. I wish there was a study on this somewhere. Appreciate your reply.

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diverjer | @diverjer | 3 days ago
In reply to @heavyphil "@chippydoo I agree…having seen some videos of this ‘bagging’ of the prostate before removal, it doesn’t..." + (show)
Profile picture for heavyphil @heavyphil

@chippydoo I agree…having seen some videos of this ‘bagging’ of the prostate before removal, it doesn’t seem very exacting and far from perfect.
There seems to be a fairly high chance for spillage, right? There’s no reason why these clumps of cells can’t reattach and regrow.
Years ago a friend had an aggressive colon cancer; after tumor removal she was reclined on the table (almost upside down) and her insides were repeatedly flushed with sterile saline to be sure no cells remained.
Makes me wonder if the 30% or so cases of recurrence after RARP are caused by the zeal to be ‘non-invasive’…
I would love to know what the numbers for recurrence were when ‘open’ surgery was performed. It’s probably out there somewhere…🤔
Phil

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@heavyphil

I didn't even think of something like that happening, but you are right it should could. Makes one wonder why they don't automatically take that into account insure it doesn't happen.

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Profile picture for payner
payner | @payner | 11 hours ago
In reply to @chippydoo "Even if they take a bunch of nodes out and don't find a positive one you..." + (show)
Profile picture for chippydoo @chippydoo

Even if they take a bunch of nodes out and don't find a positive one you can still have a reoccurrence. Surgeon took a bunch of mine but yet I never went undetectable lowest being 0.03. PC cancer can leak into the Prostate bed requiring salvage radiation. Mine was considered a margin not a node.

Jump to this post

Thank you very much for your reply. Sorry for the delayed response. I have heard of the salvage surgery.

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