Keep or remove lymph nodes with RALP prostatectomy?

@payner
Two years ago. Just had my six month PSA which continued <.04 undetectable!

My surgeon took out 10 acted like it was a normal thing to do, they were all negative. I think it depends on all the other test results and being a .95 would think a few should be tested.

I would sure add an Amen to doing pathology while in there doing surgery, sure don't know why they don't always do that- bet it's money??

@payner
My surgery ended up close to 6 hours due to pathology finding the positive margin. Insurance does pay as Medicare took care of mine and insurance companies often follow Medicare guidelines. It’s more likely the Doctors don’t want to spend the extra time for the reimbursement rate they actually receive. He may not have actually received that much more for those two extra hours. In addition his surgery schedule is messed up when positive margins come back. I know most surgeons plan their surgery days if possible with two surgeries, one morning, one afternoon. In my case I was happy I was the morning surgery. I knew he had an afternoon one scheduled. I felt bad for that guy. My additional two hours probably turned into at least a three hour delay for him as the surgeon needs a break, lunch and the surgery room needs it’s cleaning for the next surgery. It takes time to turn a surgery room after complicated surgeries.
For all this to even happen, the surgery needs to be done at a hospital that has pathology on site. Many hospitals have pushed their pathology offsite.

Appreciate your suggestion. thank you

Good point! Thank you

My RALP was in April. I had 3 lymph nodes removed, which were clear. I now feel great (though my T is still awaiting a return) and don't feel any adverse effect related to the lymph node removal. I do feel very assured that my lymph nodes were clear, so was glad he took them out.

@mark10517ny
U rather they had only took 3 from e, but they took 10 and all negative. Don't have a clue how many nodes there are in that area. Hope I don't get that lymphedema which I understand happens after removing too many nodes. I was told 10 was in what they called limited. Three sounds better.

I'm too late to give comments before your surgery. And that's okay because I have no advice. I can tell you my surgeon didn't give me any options for node removal. He just did it. Took 6. Now I have a life-time of lymphedema in both legs. Did he have to take 6? I will never know. Not a surgeon or doctor. Just a dude with cancer. Pathology on margins was clear and all the nodes were clear. Great. But he HAVE TO TAKE 6?? There is no way for us cancer patients to know. I can be angry or can accept that he's the surgeon. Or both.

@vmr3
Had you ever had lymph nodes out previously. My understanding from my surgeon was that it would be extremely unlikely to get lymphedema from removing obturator nodes. He said it would be more likely to happen with inguinal nodes as they drain to the legs versus obturator nodes drain the prostate. I was actually concerned about this and directly addressed it with him as I had prior biopsy excising inguinal nodes and core biopsies of others and was worried about the cumulative effect. Clearly you have experienced this and unless other contributing factors it must be related to your surgery. Six obturator nodes in and of itself is considered minimal. Mine took 10.