Keep or remove lymph nodes with RALP prostatectomy?

I would go with dissection of a package of obturator lymph nodes for pathology. Although your MRI and PET may indicate everything is contained as mine did, my Surgeon did use real time pathology during surgery and was surprised when margins came back positive when everything would have inferred they would not. He then needed to continue my surgery for additional two hours carefully removing more margin and my final post surgery pathology was negative margin. He took out one set of lymph nodes which were negative.

Was your decipher .95? They really don’t give you a number that is a percent, They give you a decimal between zero and one.

With everything contained, taking lymph nodes is not mandatory though taking maybe three on either side could give a look at whether there has been a small amount of spread that’s not recognized.

I know when I had my surgery they didn’t take any lymph nodes, I was a 3+4, And I’ve never had it come back in the lymph nodes and it is now 16 years later. It has come back in My spine.

I would not disturb lymph nodes unless doctor sees they are enlarged or PETSCAN reveals tracer uptake. Lymph nodes are your friends and I think they less you excise in those surgeries, the better Since you are Gleason 7, I would rely on PETSCAN . Just my opinion.

I was not given the option. My Dr. just removes them and does the testing. 6 years no return yet.

If there is even faint uptake in PSMA scan, I would ask for 2-3 closest nodes to be removed for examination.

You will have to look into PSMA report yourself since low uptake is usually dismissed as benign. For my husband it turned out not to be benign and even though we asked for faintly glowing node to be taken out and examined it was not done and it was a big mistake.

My husband now has BCR in that node and in a couple of other ones. If they examined those nodes in time he would have had RT much sooner and possibly stopped further spread to additional nodes.

Wishing you the best of luck with surgery 🍀 and may it be the only procedure that you will ever need 🍀.

Great advise! Best wishes to your husband.

Glad to hear you success! Thank you

Certainly appreciate your response. Thank you for your opinion. Greatly appreciate hearing all comments.

Thank you. I was at the extreme high end and my doctor was surprised.
I will look back at number to see how it was shown.
Appreciate your suggestion.
Thank you and glad to hear of 16 years 😊

I wish more surgeons would do the pathology in surgery.
I assume it has something to do with insurance not wanting to pay the extra cost of time.
How long ago was your surgery.
Glad to hear of yourself continued health.