Prostate Surgery With Bilateral Lymph node dissection

I think they make the decision based on how aggressive they believe the cancer to be. The pelvic lymph nodes are a very common place for the early spreading to show up. The imaging scans aren’t nearly as reliable as actually examining the nodes themselves under a microscope.

My husband was similar to you in that he had Gleason 4+4: 8, MRI showing no spread, and PSMA PET showing no spread. However he did have 2 extracapsilar extensions on the left. His surgeon is the head of the urology dept at Mayo - Jacksonville, FL. We lucked into him when he got a cancellation. When we met with him the day before surgery, he said he would take up to 10 on each side, to ensure that no spread to lymph nodes because PSMA PET was a month ago and MRI (an updated done last week) is not always 100%. Because my husband has a PSA of 24.5 plus Gleason 8, it puts him in the very high risk and an aggressive form. Surgeon said with aggressive cancers, they lean toward lymph node dissection (while they are in there) to ensure no spread. We’re dealing with all the aftermath right now but we both will feel so much better when path report comes back negative.

**Addition: My husband had bilateral mesh hernia repair by a dr who “used more mesh than I’ve ever seen” (dr.’s quote) and that made it difficult to get as many lymph nodes from the left/affected side as he wanted.

You are asolutley right: the more aggressive the cancer the more likelihood the surgeon will remove and test lymph nodesfor possible spread.

I wish your husband a complete recovery from the cancer and any lingering side effects.

Yes they have suggested radiation and ADT. But we have to get another PSA before we can get insurance to cover a PMSA! So frustrating.

Got it. Insurance companies can delay tests or treatments at times, which is a bummer!

I wish you the best of luck in your treatment.

RP in 2022. Gleason 3+4. PSA 24.5. During surgery, cancer found in seminal vesicles. 5 lymph nodes (3 on left, 2 on right) removed and all negative for cancer. One month after surgery, PSA WAS 4. PSMA showed lymph node in pelvis, farther from the prostate than taken during RP, was cancerous. Second surgery with removal of more lymph nodes. Recovery took about 4-6 weeks (I was 65 and otherwise very healthy). Worst side effect was constipation. Post lymph node dissection PSA undetectable. Followed up by salvage radiation (39 treatments) and 24 months of ADT. Two observations: I’m glad to see that PSMA scans prior to surgery are becoming more routine. It would have saved me a second surgery. My surgeon and the oncologists at St. Peter’s Hospital in Albany were in some disagreement about the follow up to my lymph node dissection, so I sought a third opinion at MSKCC in NYC. The oncologist there mentioned in passing that their surgeons would have taken more lymph nodes during the RP. That, also, might have saved me from the second surgery.

I just reviewed Dr. Walsh's book where Dr. Schaeffer describes n detail ("step by step") how he performs a prostatectomy, emphasizing how he attempts to preserve as much of the fascia as possible, and he mentions that after releasing the bladder from the anterior abdominal wall, he then performs a lymph node dissection.
It sounds like, in his case at least, it's done as a matter of course.

@ucla2025 Feel free to reach out as it seems like we are the caretakers going through the same process. I am grateful for this forum and currently looking for a local support group as well. I am new to using this website but will check it often for replies, comments, and connections.
I am feeling very overwhelmed and worried.

Hi, so nice to hear from you! I feel the same way you do. We now have had two PSA tests done since surgery, both with bad results. PSA going up. The docs want the pmsa pet scan done asap but we are still waiting to hear from the insurance company! In the meantime we have started ADT and have been referred to a radiation oncologist. I am very upset about all of it but mostly the insurance company. The doctors have all been wonderful. Now waiting on yet another PSA result. Life has been turned upside down. Thank you so much for responding to me.

Yes, I feel your pain about the insurance companies. Have you tried to call them yourself and tell them this is time sensitive? I think taking names and calling them might help, it certainly won't hurt. I hope you hear something soon.

So they won't let you schedule the PMSA pet scan just to at least get him on the schedule while you wait for insurance? Sending positive vibes your way.