Removal of lymph nodes in robotic RP

I did try and find some information on this subject. I was successful, but didn't understand it. 

A good recommendation would be to use the Macmillan Cancer Support Helpline - 0808 808 00 00 - on this one, because they would be able to breakdown the very technical information I found into actual English. 

You can also contact them using the information on this web page - community.macmillan.org.uk/.../ask_the_expert-forum

There are also other people on this forum who may be able to help you with actual experience (I went down the radiotherapy route because I had some spread into adjacent lymph nodes. They were treated together with the gland).

Hello Pura Vida 

I still have my Prostate but from my understanding the only benefits of the lymph node removal is enhanced confirmation of the original diagnosis (when they have been removed they are also used in the histology) and also once they have gone they help stop any further spread to other parts of the body.

I remember my oncologist talking about the pelvic lymph nodes as I have a "shadow" on my original MRI and the final decision was to "zap" them with radiotherapy. Don't forget I am not medically trained and this was a chat over 2 years ago!!

I wish you well with the surgery - please do keep us informed as to how it goes.

Best wishes - Brian.

Hi Pura Vida  I’ve just read your bio : very interesting. You have been through a lot of biopsies!!  However, so far, you have kept a cool head (although I’m not surprised that you haven’t been treated , as they couldn’t find any cancer for so many years).  Once it turned to a Gleason 7, your bio states that HT and RT is likely (which would be my choice too), so what changed to go for removal after so many years of calm consideration?  The comment about lymphoedema (fluid retention) is valid but not inevitable by any means (depends how many nodes are removed).  The thing I don’t understand is that the surgeon appears to be talking about removing them “just in case” , despite the attendant risks. It’s a bit like cutting your nose off in case you have a nasty boil on it, rather than treating the boil. Radiotherapy can kill any trace cancer in nodes (in the pelvis, within its computed target area of course).  Anyway, that aside, your team have studied your high PSA secreting cancer so carefully over the years , so I expect either treatment to be successful. Your decision to say no to lymph node removal is correct in my opinion - even if cancer is subsequently found in them, it can be treated later by salvage radiotherapy. However, you will then have two sets of side effects - one from prostatectomy and one from radiotherapy/ hormone therapy.   AW

Thanks, Steve. Good suggestion.

Hi AW.

In the end my treatment decision was based more on my mental health than physical health. During the 10 years I have been on the journey towards treatment, the regular cycle every 6-12 months of PSA tests, MRIs and biopsies has triggered bouts of depression and anxiety. I have had next to no symptoms from the cancer. Surgery is a way for me to complete treatment sooner and begin recovery to break the cycle. I think I am young and fit enough to cope with the surgery and side effects. I know the outcomes are the same, but surgery represents for me a tangible intervention that I can focus on, whereas 6 months on HT and 4 weeks of RT,  is harder for me to endure. Both the oncologist and surgeon recommended RP after talking through my history and concerns.

I am reassured by the recovery rates and success in dealing with incontinence, but less assured about recovery of natural erections. They aim to spare the right side nerve bundle as the tumor is on the left, which increases my chances. It was quoted that 6/10 men suffer permanent ED when one nerve side is spared. I look at as, there is a 40% chance I will recover natural erections. And the word natural is important there, because you can obviously induce erections with pumps, injections, implants, etc. This is not an end to my sex life, just a new chapter. I know 100% that I will not be able to ejaculate again, but there is no reason why I can't continue to experience erections, natural or induced, and to experience dry orgasms.

Sex is important to me, but not as important as my well being. I fear that HT, particularly, would impact on my well being.

It's a complicated decision. I have had years to think about what I would chose when this day came. Although I have flip flopped alot over the years, over the last year I have reinforced my decision that surgery is the right choice for me.

Hi Pura Vida that is a comprehensive reply- thank you so much for explaining the reasoning behind your ultimate decision. I totally understand: after all those biopsies I think I would be struggling mentally too !  Looking back, after some biopsies that failed to find cancer, I’m surprised that your team didn’t go for a PSMA PET scan to save you having to endure more biopsies.  Anyway, they’ve found it now and it’s not aggressive.  So I feel very confident that you are firmly on a curative pathway.  All the best for the operation and come back & let us know how it goes.  We have many contributors on here who can offer advice on any aspect post op.   AW

Of course, you are still in conversation with the specialist teams at Addenbrookes.  Did you consider Brachytherapy Boost (I had it done at Addenbrookes).  Have you read my bio?   AW

Have you been given a date for prostatectomy?  AW

Not yet, but going for pre-op tomorrow in case of cancelations earlier than the 8-10 weeks, so they can put me on a short notice list.

They are such a great team there (as one would expect of a world class hospital backed up by research facilities and Cambridge university researchers).   AW