Lymph nodes question

I strongly doubt that you are finished.

My staging is slightly worse than that - T3B N1 M0. The MRI and CT scan suggest only 1 lymph node affect BUT the oncologist says they are going to "cover them all" without specifing a number. Apparently I am having "radical radiotherapy" with "curative intent".

I am good with that but will be getting 37 RT sessions as opposed to the 20 that is the norm. I am most of the way through 6 months HT to shrink everything before the RT. According to my last appointment, I am on track starting the first week in January.

My imagination has my oncologist standing over a smoking prostate whilst holding a Star Trek type phaser.

The number of lymph nodes, other than the one considered to be a definite, has not been discussed.

So, to reiterate, I do not think you to be finished. Perhaps, by comparison with others still going strong on here, you are just starting.

Your stage is much better, with only 1 lymph node you still have curative possibilities, me with 5 not so much ,they say max is 4 lymph nodes for curative intent. 

Hello Murcao . Different countries have different criteria but in general terms the more lymph nodes involved then the greater the risk that there could be others which haven't shown up yet and also that the cancer cells might have already spread further throughout the body. Radical radiotherapy would zap both the prostate and the lymph nodes in the pelvic area (there are on average 26-28 lymph nodes there). Some lymph nodes are more difficult to treat because of their position close to other organs. The cells which have seeded elsewhere can remain dormant for many years thanks to the hormone therapy but then can start to multiply and grow a new lesion. The more the cancer is found to have spread when first diagnosed then the more aggressive the treatment should be to try and kill off as much cancer as possible but as we have learnt on this forum there are different treatment pathways available which might include any combination of different types of HT, radiotherapy and chemotherapy. How long these therapies are effective for can vary from person to person. If your cancer burden is initially high then there is more chance that not all of it can be killed off by the initial radical treatment and so you are more likely to have it popping up elsewhere later on as the seeded cells, by nature, are more aggressive and resistant to treatment. This is why so much work is being done on finding targeted therapies which can hone in on the individual cells with things like radioligands such as Lutetium 177. This is just one of the new tools becoming available.

Even if the experts say it is incurable, it doesn't mean it is untreatable for many years. My husband is one of the incurables but we had an interesting conversation with his urologist this morning who basically said he is alive because of the developments in prostate cancer treatment over the last 10 years which have been phenomenal but also that the future looks even more promising.

Thanks is always good talking to you, my mind was still in the cure possibility, I still don't accepted the idea of incurable, my hope is if till 4 lymph nodes it's curable then 5 will not be the end of the road , I'm terrified that the oncologist next Friday is a pessimistic person and don't give me the hope I'm so much needed. 

My lymph nodes positive are all in the pelvis. 

If  saying 4 is curable and 5 not then u would have to get a second opinion, something so important especially as u don't seem that keen on the specialist.

Steve 

The lymph nodes are in chains like branches off of the main trunk of a tree. If the cancer is just in 1 or 2 branches then this is better than if 5 individual branches are involved.

I had 10 suspicious, end up for being 5 ,u want that thing double checked. 

Sometimes.its worth it.

If 4 curable and 5 not then a different expert's opinion could be worth considering.

Hi !

I’ve never seen a distinction between 4 or 5 lymph nodes to treat a T2CN1M0. Alwayshope has of course a valid point that, the more lymph nodes affected that this might affect the overall prognosis.

I did a ChatGPT queries. IT’S IMPORTANT TO REMEMBER that ChatGPT is a TOOL and you ALWAYS need to consult the medical experts, in your case Oncologists (not Urologists). But you can always use the information in your dialouge with the medical team to hear the opinion from then.

QUESTION 1:

When having a diagnos of T2CN1M0, is it not possible to have radiation treatment with curative intent if you have 5 affected lymph nodes? Can you only have radiation treatment with curative intent when you have 4 affected lymph nodes or less?

ANSWER 1:

No, a diagnosis of T2cN1M0 with 5 affected lymph nodes does not automatically prevent a patient from receiving radiation treatment with curative intent. The presence of multiple positive lymph nodes (even if there are 5 or more) does not serve as a strict threshold that limits curative-intent treatment. Instead, treatment guidelines generally support the use of curative-intent therapy, combining radiation therapy (RT) and androgen deprivation therapy (ADT), for node-positive (N1), M0 prostate cancer, regardless of the exact number of positive lymph nodes.

Key Points:

1. Curative Intent in Node-Positive (N1) Disease: Curative-intent radiation combined with long-term ADT is often recommended for patients with locally advanced, node-positive (N1) prostate cancer without distant metastasis (M0), as studies have shown improved outcomes with this approach, even for cases with several affected lymph nodes.

2. No Fixed Cutoff: The difference between 4 and 5 positive lymph nodes does not typically change the approach from curative to palliative intent. Instead, the number of nodes might influence the treatment’s intensity (e.g., the radiation field or ADT duration), but it generally does not prevent offering a curative-intent regimen.

3. Guidelines Support Curative Treatment for Multiple Nodes: The European Association of Urology (EAU) and other major guidelines support treating high-risk, node-positive prostate cancer (even with multiple positive nodes) with RT and ADT. These guidelines recognize that curative-intent radiation provides survival benefits for patients with regional node involvement (N1), as long as the disease has not spread beyond the pelvis (M0).

4. Individualized Treatment Decisions: The specific treatment approach—such as whether to use whole-pelvic radiation, duration of ADT, and radiation dose—may be tailored based on factors like PSA, Gleason score, overall health, and patient preferences. However, having 5 positive nodes does not typically change the overall curative intent.

Summary:

For T2cN1M0 prostate cancer with 5 affected lymph nodes, curative-intent treatment is still possible and often recommended. There is no strict cutoff at 4 nodes that would preclude curative-intent radiation. Instead, the focus remains on combining RT and ADT to achieve the best possible outcomes, regardless of the exact number of positive lymph nodes.

QUESTION 2

What is EU standard treatment of T2CN1M0 when doing primary radiation treatment with ADT and with a curative intent?

ANSWER 2:

In Europe, the standard treatment for T2cN1M0 prostate cancer—indicating a tumor confined to the prostate with regional lymph node involvement but no distant metastasis—typically involves a combination of primary radiation therapy (RT) and androgen deprivation therapy (ADT), administered with curative intent.

Treatment Components:

1. Radiation Therapy (RT):

• External Beam Radiation Therapy (EBRT): This is the primary modality, delivering precise radiation doses to the prostate and affected lymph nodes. Techniques such as Intensity-Modulated Radiation Therapy (IMRT) or Volumetric Modulated Arc Therapy (VMAT) are commonly employed to maximize tumor control while minimizing exposure to surrounding healthy tissues.

• Whole Pelvic Radiation Therapy (WPRT): Given the involvement of regional lymph nodes (N1), WPRT is often utilized to target both the prostate and the pelvic lymphatic region, addressing potential microscopic disease spread.

2. Androgen Deprivation Therapy (ADT):

• Neoadjuvant and Concurrent ADT: ADT is typically initiated before and continued during radiation therapy to reduce androgen levels, thereby enhancing the effectiveness of radiation.

• Adjuvant ADT: Following the completion of radiation therapy, ADT may be continued for a duration ranging from 2 to 3 years, depending on individual risk factors and response to treatment.

Clinical Guidelines:

The European Association of Urology (EAU) provides guidelines for the management of prostate cancer. For patients with locally advanced disease, including those with N1 involvement, the EAU recommends:

• Radiotherapy: Offering external beam radiation therapy to the prostate and pelvic lymph nodes.

• ADT: Administering long-term ADT for at least two years in conjunction with radiotherapy.

These recommendations are based on evidence indicating that the combination of RT and ADT improves survival outcomes in patients with node-positive prostate cancer .

Individualized Treatment Planning:

Treatment plans are tailored based on factors such as the number and size of affected lymph nodes, Gleason score, PSA levels, and overall patient health. Multidisciplinary teams, including urologists, radiation oncologists, and medical oncologists, collaborate to develop personalized treatment strategies.

Consultation with Healthcare Providers:

It’s essential to discuss your specific case with your healthcare team to understand the rationale behind the recommended treatment plan and to explore all available options. They can provide detailed information on the expected benefits and potential side effects, helping you make an informed decision about your care.

Remember as well, you’re living in a EU Country and you might have the opportunity to have a treatment in another EU country if your Health care system don’t offer you a treatment that is considered standard praxis.

I really you should ask for second opinion because that’s within your rights

Best wishes - Ulf