Re: Is removal of lymph nodes an option?

July 22, 2010

Sandy, all I can tell you is that they did remove my lymph nodes, plus surrounding tissue. Glad they did going on 7 yrs being cancer free.

Childers

Subject: Is removal of lymph nodes an option?To: ProstateCancerSupport Date: Thursday, July 22, 2010, 7:23 PM

Hi Everyone. My husband was diagnosed with prostate cancer 2 weeks ago. Initially, we were pleased with his urologist - he was very kind and informative when breaking the news to us. We went to see him last night with some additional questions. We're leaning towards the robotic surgery. Everything I've read says the lymph nodes should be removed and biopsied, but he says he does not do that. I'm truly perplexed by this because how will we know whether the cancer has spread?A little history (I don't have the exact numbers in front of me):My husbands PSA went from around a 2 - 4 from one year to the next. Then it jumped from a 4 to 6+. The urologist did not think cancer would cause such a jump, so he was treated for prostatitis. But after a month on antibiotics, the PSA did not go down. So a biopsy was done, which showed he had prostate cancer. Five cores had definitive signs of cancer, one was suspiscious and one noted chronic

prostatitis. The Gleason was a mix of 6's and 7's, with the first number being a 3 (I think for all or most). I've made an appointment for another urologist for next Wednesday. I also have an appointment with a surgical oncologist at Fox Chase, but could not get him in for another 3 weeks. Of course I'm afraid that we are putting things off too long - I don't want the cancer to spread, but I know we only have one shot at at least trying to get this right the first time. Not biopsying the lymph nodes causes me a lot of concern. Is that something that should always be done? The urologist is saying that the cancer isn't aggressive enough to warrant the removal of the lymph nodes.Any thoughts you can give me on this would be greatly appreciated.Thanks so much!Sandy

July 22, 2010

Sorry to hear your news Sandy. From what you have posted a delay of

some weeks or months should not be dangerous – as your urologist has surmised

from the evidence he has available the cancer probably isn’t a very

aggressive form of the disease.

The question of removing the lymph nodes

is one of many aspects where there is little agreement between the experts. It is

my understanding that the RALP (Robotic Assisted Laparoscopic Prostatectomy)

procedure makes the removal of the nodes very much more difficult than it is

with the open RP (Radical Prostatectomy). No doubt others wil correct me if I am

incorrect in that assumption.

Just one point I’d make is this. You

say <snip> The urologist is saying that the cancer isn't aggressive

enough to warrant the removal of the lymph nodes. <snip> That being the

case is it essential to remove the prostate gland? Is Active Surveillance an

option that should be considered?

All the best

Prostate men need enlightening, not

frightening

Terry Herbert - diagnosed in 1996 and

still going strong

Read A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html

From:

ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of s_l_toth

Sent: Friday, 23 July 2010 10:24

AM

To:

ProstateCancerSupport

Subject:

Is removal of lymph nodes an option?

Hi Everyone. My husband was diagnosed with prostate

cancer 2 weeks ago. Initially, we were pleased with his urologist - he was very

kind and informative when breaking the news to us. We went to see him last

night with some additional questions. We're leaning towards the robotic

surgery. Everything I've read says the lymph nodes should be removed and

biopsied, but he says he does not do that. I'm truly perplexed by this because

how will we know whether the cancer has spread?

A little history (I don't have the exact numbers in front of me):

My husbands PSA went from around a 2 - 4 from one year to the next. Then it

jumped from a 4 to 6+. The urologist did not think cancer would cause such a

jump, so he was treated for prostatitis. But after a month on antibiotics, the

PSA did not go down. So a biopsy was done, which showed he had prostate cancer.

Five cores had definitive signs of cancer, one was suspiscious and one noted

chronic prostatitis. The Gleason was a mix of 6's and 7's, with the first

number being a 3 (I think for all or most).

I've made an appointment for another urologist for next Wednesday. I also have

an appointment with a surgical oncologist at Fox Chase, but could not get him

in for another 3 weeks. Of course I'm afraid that we are putting things off too

long - I don't want the cancer to spread, but I know we only have one shot at

at least trying to get this right the first time.

Not biopsying the lymph nodes causes me a lot of concern. Is that something

that should always be done? The urologist is saying that the cancer isn't

aggressive enough to warrant the removal of the lymph nodes.

Any thoughts you can give me on this would be greatly appreciated.

Thanks so much!

Sandy

July 22, 2010

Sandy,

From what you have told us, a few weeks' delay should not be a big concern. I had 7 positive cores out of 12, 3+4 for a Gleason 7, and two abnormal but not yet cancerous. My urologist told me to take my time and study everything I could find on the various treatment options (which he outlined), before making my decision on treatment. However, he said I should not wait six months, only a month or two at most. I was Diagnosed Nov. 19, 2009 and had DaVinci surgery Jan. 28, 2010. So far all is well, though ED is still an issue.

I suggest you and your husband read everything you can on websites such as that of the Prostate Cancer Research Institute, which has a great three-part series on treatment options and how to make the decision. It also has articles on the latest research findings.

I found the prostate cancer section of the Memorial Sloan Kettering Cancer Center website invaluable. You will find in it a calculator, called the Katten Nomogram. You enter your scores, PSA, Gleason etc. and it will tell you the chances of being cancer free for five and 10 (sometimes only 8) years for the various treatment options. It also has excellent articles.

The yananow.net website also is wonderful. You can read how hundreds of men made their treatment decisions and their treatment experiences and results. In some ways this is the most useful site of all, but it is only really useful after you have become familiar with the treatment options and their advantages and disadvantages. Mike

Subject: Is removal of lymph nodes an option?To: ProstateCancerSupport Date: Thursday, July 22, 2010, 8:23 PM

Hi Everyone. My husband was diagnosed with prostate cancer 2 weeks ago. Initially, we were pleased with his urologist - he was very kind and informative when breaking the news to us. We went to see him last night with some additional questions. We're leaning towards the robotic surgery. Everything I've read says the lymph nodes should be removed and biopsied, but he says he does not do that. I'm truly perplexed by this because how will we know whether the cancer has spread?A little history (I don't have the exact numbers in front of me):My husbands PSA went from around a 2 - 4 from one year to the next. Then it jumped from a 4 to 6+. The urologist did not think cancer would cause such a jump, so he was treated for prostatitis. But after a month on antibiotics, the PSA did not go down. So a biopsy was done, which showed he had prostate cancer. Five cores

had definitive signs of cancer, one was suspiscious and one noted chronic prostatitis. The Gleason was a mix of 6's and 7's, with the first number being a 3 (I think for all or most). I've made an appointment for another urologist for next Wednesday. I also have an appointment with a surgical oncologist at Fox Chase, but could not get him in for another 3 weeks. Of course I'm afraid that we are putting things off too long - I don't want the cancer to spread, but I know we only have one shot at at least trying to get this right the first time. Not biopsying the lymph nodes causes me a lot of concern. Is that something that should always be done? The urologist is saying that the cancer isn't aggressive enough to warrant the removal of the lymph nodes.Any thoughts you can give me on this would be greatly appreciated.Thanks so

much!Sandy------------------------------------There are just two rules for this group 1 No Spam 2 Be kind to othersPlease recognise that Prostate Cancerhas different guises and needs different levels of treatment and in some cases no treatment at all. Some men even with all options offered chose radical options that you would not choose. We only ask that people be informed before choice is made, we cannot and should not tell other members what to do, other than look at other options. Try to delete old material that is no longer applying when clicking replyTry to change the title if the content requires it

July 22, 2010

If the surgical treatment option is chosen, biopsy of the lymph node(s) is an option. If the surgical access method is perineal (behind the rectum), the lymph node is not taken (this method is considered to be relatively old-fashioned, but has healing speed comparable to robotic retropubic surgery). However, with any of the surgical method, the seminal vesicle is removed and studied for spread. Generally if the margins are clean, then lymph node removal is not done. If there is spread past the margins.

The need or preference for lymph node biopsy is generally up to the urologist or urological surgeon.

Louis. . . .

To: ProstateCancerSupport Sent: Thu, July 22, 2010 8:23:59 PMSubject: Is removal of lymph nodes an option?

Hi Everyone. My husband was diagnosed with prostate cancer 2 weeks ago. Initially, we were pleased with his urologist - he was very kind and informative when breaking the news to us. We went to see him last night with some additional questions. We're leaning towards the robotic surgery. Everything I've read says the lymph nodes should be removed and biopsied, but he says he does not do that. I'm truly perplexed by this because how will we know whether the cancer has spread?A little history (I don't have the exact numbers in front of me):My husbands PSA went from around a 2 - 4 from one year to the next. Then it jumped from a 4 to 6+. The urologist did not think cancer would cause such a jump, so he was treated for prostatitis. But after a month on antibiotics, the PSA did not go down. So a biopsy was done, which showed he had prostate cancer. Five cores had definitive signs of cancer, one was suspiscious and one noted chronic

prostatitis. The Gleason was a mix of 6's and 7's, with the first number being a 3 (I think for all or most). I've made an appointment for another urologist for next Wednesday. I also have an appointment with a surgical oncologist at Fox Chase, but could not get him in for another 3 weeks. Of course I'm afraid that we are putting things off too long - I don't want the cancer to spread, but I know we only have one shot at at least trying to get this right the first time. Not biopsying the lymph nodes causes me a lot of concern. Is that something that should always be done? The urologist is saying that the cancer isn't aggressive enough to warrant the removal of the lymph nodes.Any thoughts you can give me on this would be greatly appreciated.Thanks so much!Sandy

July 23, 2010

Hi . That's wonderful news about the 7 years. I guess I would feel better

if they remove the lymph nodes just to have a bit of additional information on

how bad the cancer is.

Thank you for your response.

Sandy

>

> Subject: Is removal of lymph nodes an option?

> To: ProstateCancerSupport

> Date: Thursday, July 22, 2010, 7:23 PM

>

> Â

>

> Hi Everyone. My husband was diagnosed with prostate cancer 2 weeks ago.

Initially, we were pleased with his urologist - he was very kind and informative

when breaking the news to us. We went to see him last night with some additional

questions. We're leaning towards the robotic surgery. Everything I've read says

the lymph nodes should be removed and biopsied, but he says he does not do that.

I'm truly perplexed by this because how will we know whether the cancer has

spread?

>

> A little history (I don't have the exact numbers in front of me):

>

> My husbands PSA went from around a 2 - 4 from one year to the next. Then it

jumped from a 4 to 6+. The urologist did not think cancer would cause such a

jump, so he was treated for prostatitis. But after a month on antibiotics, the

PSA did not go down. So a biopsy was done, which showed he had prostate cancer.

Five cores had definitive signs of cancer, one was suspiscious and one noted

chronic prostatitis. The Gleason was a mix of 6's and 7's, with the first number

being a 3 (I think for all or most).

>

> I've made an appointment for another urologist for next Wednesday. I also have

an appointment with a surgical oncologist at Fox Chase, but could not get him in

for another 3 weeks. Of course I'm afraid that we are putting things off too

long - I don't want the cancer to spread, but I know we only have one shot at at

least trying to get this right the first time.

>

> Not biopsying the lymph nodes causes me a lot of concern. Is that something

that should always be done? The urologist is saying that the cancer isn't

aggressive enough to warrant the removal of the lymph nodes.

>

> Any thoughts you can give me on this would be greatly appreciated.

>

> Thanks so much!

>

> Sandy

>

July 23, 2010

Hi Terry. Thanks for your response. The surgeon we talked to does do the da

Vinci surgery, so maybe that's why he doesn't remove the lymph nodes. But he

said the doctors at Jefferson always do and I know Jefferson is a good hospital.

As for the watchful waiting approach, he did not offer that as an option, nor

did the radiologist that we spoke to. And I guess based on the test results and

what I've read so far, that does not seem like a good option. And we got

conflicting info - the urologist called it a low risk cancer and the radiologist

said it was intermediate. So we're off for another opinion, and maybe a third.

Thanks again!

Sandy

>

> Sorry to hear your news Sandy. From what you have posted a delay of some

> weeks or months should not be dangerous - as your urologist has surmised

> from the evidence he has available the cancer probably isn't a very

> aggressive form of the disease.

>

> The question of removing the lymph nodes is one of many aspects where there

> is little agreement between the experts. It is my understanding that the

> RALP (Robotic Assisted Laparoscopic Prostatectomy) procedure makes the

> removal of the nodes very much more difficult than it is with the open RP

> (Radical Prostatectomy). No doubt others wil correct me if I am incorrect in

> that assumption.

>

> Just one point I'd make is this. You say <snip> The urologist is saying that

> the cancer isn't aggressive enough to warrant the removal of the lymph

> nodes. <snip> That being the case is it essential to remove the prostate

> gland? Is Active Surveillance an option that should be considered?

>

> All the best

>

> Prostate men need enlightening, not frightening

>

> Terry Herbert - diagnosed in 1996 and still going strong

>

> Read A Strange Place for unbiased information at

> http://www.yananow.net/StrangePlace/index.html

>

> _____

>

> From: ProstateCancerSupport

> [mailto:ProstateCancerSupport ] On Behalf Of s_l_toth

> Sent: Friday, 23 July 2010 10:24 AM

> To: ProstateCancerSupport

> Subject: Is removal of lymph nodes an option?

>

> Hi Everyone. My husband was diagnosed with prostate cancer 2 weeks ago.

> Initially, we were pleased with his urologist - he was very kind and

> informative when breaking the news to us. We went to see him last night with

> some additional questions. We're leaning towards the robotic surgery.

> Everything I've read says the lymph nodes should be removed and biopsied,

> but he says he does not do that. I'm truly perplexed by this because how

> will we know whether the cancer has spread?

>

> A little history (I don't have the exact numbers in front of me):

>

> My husbands PSA went from around a 2 - 4 from one year to the next. Then it

> jumped from a 4 to 6+. The urologist did not think cancer would cause such a

> jump, so he was treated for prostatitis. But after a month on antibiotics,

> the PSA did not go down. So a biopsy was done, which showed he had prostate

> cancer. Five cores had definitive signs of cancer, one was suspiscious and

> one noted chronic prostatitis. The Gleason was a mix of 6's and 7's, with

> the first number being a 3 (I think for all or most).

>

> I've made an appointment for another urologist for next Wednesday. I also

> have an appointment with a surgical oncologist at Fox Chase, but could not

> get him in for another 3 weeks. Of course I'm afraid that we are putting

> things off too long - I don't want the cancer to spread, but I know we only

> have one shot at at least trying to get this right the first time.

>

> Not biopsying the lymph nodes causes me a lot of concern. Is that something

> that should always be done? The urologist is saying that the cancer isn't

> aggressive enough to warrant the removal of the lymph nodes.

>

> Any thoughts you can give me on this would be greatly appreciated.

>

> Thanks so much!

>

> Sandy

>

July 23, 2010

Hi Mike. I'm glad to hear you are doing well after your surgery. And thank you

for the information. As you know, it can be overwhelming trying to sort through

everything. I've been checking out some of the websites like Mayo Clinic and

Fox Chase. We recently found Yananow - it is a good website and it provides

links to so much additional information. I'll definitely check out the Sloan

Kettering website.

I guess since they can't remove the prostate until 8-10 weeks after the biopsy,

we do still have a little time to see doctors.

When you had your surgery, did they remove the lymph nodes?

Thanks again!

Sandy

>

> Subject: Is removal of lymph nodes an option?

> To: ProstateCancerSupport

> Date: Thursday, July 22, 2010, 8:23 PM

>

> Hi Everyone. My husband was diagnosed with prostate cancer 2 weeks ago.

Initially, we were pleased with his urologist - he was very kind and informative

when breaking the news to us. We went to see him last night with some

additional questions. We're leaning towards the robotic surgery. Everything

I've read says the lymph nodes should be removed and biopsied, but he says he

does not do that. I'm truly perplexed by this because how will we know whether

the cancer has spread?

>

> A little history (I don't have the exact numbers in front of me):

>

> My husbands PSA went from around a 2 - 4 from one year to the next. Then it

jumped from a 4 to 6+. The urologist did not think cancer would cause such a

jump, so he was treated for prostatitis. But after a month on antibiotics, the

PSA did not go down. So a biopsy was done, which showed he had prostate

cancer. Five cores had definitive signs of cancer, one was suspiscious and one

noted chronic prostatitis. The Gleason was a mix of 6's and 7's, with the first

number being a 3 (I think for all or most).

>

> I've made an appointment for another urologist for next Wednesday. I also

have an appointment with a surgical oncologist at Fox Chase, but could not get

him in for another 3 weeks. Of course I'm afraid that we are putting things off

too long - I don't want the cancer to spread, but I know we only have one shot

at at least trying to get this right the first time.

>

> Not biopsying the lymph nodes causes me a lot of concern. Is that something

that should always be done? The urologist is saying that the cancer isn't

aggressive enough to warrant the removal of the lymph nodes.

>

> Any thoughts you can give me on this would be greatly appreciated.

>

> Thanks so much!

>

> Sandy

>

> ------------------------------------

>

> There are just two rules for this group

> 1 No Spam

> 2 Be kind to others

>

> Please recognise that Prostate Cancerhas different guises and needs different

levels of treatment and in some cases no treatment at all. Some men even with

all options offered chose radical options that you would not choose. We only ask

that people be informed before choice is made, we cannot and should not tell

other members what to do, other than look at other options.

>

> Try to delete old material that is no longer applying when clicking reply

> Try to change the title if the content requires it

July 23, 2010

Thanks Louis! I guess that's why it might be a good idea to talk to another

surgeon or two. I kind of got the feeling that removal of the lymph nodes was

standard procedure, but evidently not.

The urologist did say they remove the seminal veiscle, but he did not say they

biopsy it during the surgery to determine if the lymph nodes get removed - he

just does not remove the lymph nodes because it's an additional surgical

procedure.

Sandy

>

> If the surgical treatment option is chosen, biopsy of the lymph node(s) is an

> option. If the surgical access method is perineal (behind the rectum), the

lymph

> node is not taken (this method is considered to be relatively old-fashioned,

but

> has healing speed comparable to robotic retropubic surgery). However, with any

> of the surgical method, the seminal vesicle is removed and studied for spread.

> Generally if the margins are clean, then lymph node removal is not done. If

> there is spread past the margins.

>

> The need or preference for lymph node biopsy is generally up to the urologist

or

> urological surgeon.

>

> Louis. . . .

>

> ________________________________

>

> To: ProstateCancerSupport

> Sent: Thu, July 22, 2010 8:23:59 PM

> Subject: Is removal of lymph nodes an option?

>

> Â

> Hi Everyone. My husband was diagnosed with prostate cancer 2 weeks ago.

> Initially, we were pleased with his urologist - he was very kind and

informative

> when breaking the news to us. We went to see him last night with some

additional

> questions. We're leaning towards the robotic surgery. Everything I've read

says

> the lymph nodes should be removed and biopsied, but he says he does not do

that.

> I'm truly perplexed by this because how will we know whether the cancer has

> spread?

>

> A little history (I don't have the exact numbers in front of me):

>

> My husbands PSA went from around a 2 - 4 from one year to the next. Then it

> jumped from a 4 to 6+. The urologist did not think cancer would cause such a

> jump, so he was treated for prostatitis. But after a month on antibiotics, the

> PSA did not go down. So a biopsy was done, which showed he had prostate

cancer.

> Five cores had definitive signs of cancer, one was suspiscious and one noted

> chronic prostatitis. The Gleason was a mix of 6's and 7's, with the first

number

> being a 3 (I think for all or most).

>

> I've made an appointment for another urologist for next Wednesday. I also have

> an appointment with a surgical oncologist at Fox Chase, but could not get him

in

> for another 3 weeks. Of course I'm afraid that we are putting things off too

> long - I don't want the cancer to spread, but I know we only have one shot at

at

> least trying to get this right the first time.

>

> Not biopsying the lymph nodes causes me a lot of concern. Is that something

that

> should always be done? The urologist is saying that the cancer isn't

aggressive

> enough to warrant the removal of the lymph nodes.

>

> Any thoughts you can give me on this would be greatly appreciated.

>

> Thanks so much!

>

> Sandy

>

July 23, 2010

Dave,

My friend had breast cancer and had her lymph nodes removed. This caused

continuing collection of fluid. She has to wear a pressure bandage on her arm at

times to prevent swelling. She has been told that this is normal and will not go

away. (She was also told to stay away from wine and alcohol.) No information on

this " side effect " was given to her before the surgery.

So, it seems to be a secret about lymph node removal!

Lynn

> >

> > If the surgical treatment option is chosen, biopsy of the lymph node(s) is

an

> > option. If the surgical access method is perineal (behind the rectum), the

lymph

> > node is not taken (this method is considered to be relatively old-fashioned,

but

> > has healing speed comparable to robotic retropubic surgery). However, with

any

> > of the surgical method, the seminal vesicle is removed and studied for

spread.

> > Generally if the margins are clean, then lymph node removal is not done. If

> > there is spread past the margins.

> >

> > The need or preference for lymph node biopsy is generally up to the

urologist or

> > urological surgeon.

> >

> > Louis. . . .

> >

> > ________________________________

> > From: s_l_toth <s_l_toth@>

> > To: ProstateCancerSupport

<mailto:ProstateCancerSupport%40yahoogroups.com>

> > Sent: Thu, July 22, 2010 8:23:59 PM

> > Subject: Is removal of lymph nodes an option?

> >

> > Ã‚

> > Hi Everyone. My husband was diagnosed with prostate cancer 2 weeks ago.

> > Initially, we were pleased with his urologist - he was very kind and

informative

> > when breaking the news to us. We went to see him last night with some

additional

> > questions. We're leaning towards the robotic surgery. Everything I've read

says

> > the lymph nodes should be removed and biopsied, but he says he does not do

that.

> > I'm truly perplexed by this because how will we know whether the cancer has

> > spread?

> >

> > A little history (I don't have the exact numbers in front of me):

> >

> > My husbands PSA went from around a 2 - 4 from one year to the next. Then it

> > jumped from a 4 to 6+. The urologist did not think cancer would cause such a

> > jump, so he was treated for prostatitis. But after a month on antibiotics,

the

> > PSA did not go down. So a biopsy was done, which showed he had prostate

cancer.

> > Five cores had definitive signs of cancer, one was suspiscious and one noted

> > chronic prostatitis. The Gleason was a mix of 6's and 7's, with the first

number

> > being a 3 (I think for all or most).

> >

> > I've made an appointment for another urologist for next Wednesday. I also

have

> > an appointment with a surgical oncologist at Fox Chase, but could not get

him in

> > for another 3 weeks. Of course I'm afraid that we are putting things off too

> > long - I don't want the cancer to spread, but I know we only have one shot

at at

> > least trying to get this right the first time.

> >

> > Not biopsying the lymph nodes causes me a lot of concern. Is that something

that

> > should always be done? The urologist is saying that the cancer isn't

aggressive

> > enough to warrant the removal of the lymph nodes.

> >

> > Any thoughts you can give me on this would be greatly appreciated.

> >

> > Thanks so much!

> >

> > Sandy

> >

>

> No virus found in this incoming message.

> Checked by AVG - www.avg.com

> Version: 9.0.851 / Virus Database: 271.1.1/3023 - Release Date: 07/23/10

01:36:00

>

July 23, 2010

Dave,

My friend had breast cancer and had her lymph nodes removed. This caused

continuing collection of fluid. She has to wear a pressure bandage on her arm at

times to prevent swelling. She has been told that this is normal and will not go

away. (She was also told to stay away from wine and alcohol.) No information on

this " side effect " was given to her before the surgery.

So, it seems to be a secret about lymph node removal!

Lynn

> >

> > If the surgical treatment option is chosen, biopsy of the lymph node(s) is

an

> > option. If the surgical access method is perineal (behind the rectum), the

lymph

> > node is not taken (this method is considered to be relatively old-fashioned,

but

> > has healing speed comparable to robotic retropubic surgery). However, with

any

> > of the surgical method, the seminal vesicle is removed and studied for

spread.

> > Generally if the margins are clean, then lymph node removal is not done. If

> > there is spread past the margins.

> >

> > The need or preference for lymph node biopsy is generally up to the

urologist or

> > urological surgeon.

> >

> > Louis. . . .

> >

> > ________________________________

> > From: s_l_toth <s_l_toth@>

> > To: ProstateCancerSupport

<mailto:ProstateCancerSupport%40yahoogroups.com>

> > Sent: Thu, July 22, 2010 8:23:59 PM

> > Subject: Is removal of lymph nodes an option?

> >

> > Ã‚

> > Hi Everyone. My husband was diagnosed with prostate cancer 2 weeks ago.

> > Initially, we were pleased with his urologist - he was very kind and

informative

> > when breaking the news to us. We went to see him last night with some

additional

> > questions. We're leaning towards the robotic surgery. Everything I've read

says

> > the lymph nodes should be removed and biopsied, but he says he does not do

that.

> > I'm truly perplexed by this because how will we know whether the cancer has

> > spread?

> >

> > A little history (I don't have the exact numbers in front of me):

> >

> > My husbands PSA went from around a 2 - 4 from one year to the next. Then it

> > jumped from a 4 to 6+. The urologist did not think cancer would cause such a

> > jump, so he was treated for prostatitis. But after a month on antibiotics,

the

> > PSA did not go down. So a biopsy was done, which showed he had prostate

cancer.

> > Five cores had definitive signs of cancer, one was suspiscious and one noted

> > chronic prostatitis. The Gleason was a mix of 6's and 7's, with the first

number

> > being a 3 (I think for all or most).

> >

> > I've made an appointment for another urologist for next Wednesday. I also

have

> > an appointment with a surgical oncologist at Fox Chase, but could not get

him in

> > for another 3 weeks. Of course I'm afraid that we are putting things off too

> > long - I don't want the cancer to spread, but I know we only have one shot

at at

> > least trying to get this right the first time.

> >

> > Not biopsying the lymph nodes causes me a lot of concern. Is that something

that

> > should always be done? The urologist is saying that the cancer isn't

aggressive

> > enough to warrant the removal of the lymph nodes.

> >

> > Any thoughts you can give me on this would be greatly appreciated.

> >

> > Thanks so much!

> >

> > Sandy

> >

>

> No virus found in this incoming message.

> Checked by AVG - www.avg.com

> Version: 9.0.851 / Virus Database: 271.1.1/3023 - Release Date: 07/23/10

01:36:00

>

July 23, 2010

Thanks Mike!

Sandy

> >

> > From: s_l_toth <s_l_toth@>

> > Subject: Is removal of lymph nodes an option?

> > To: ProstateCancerSupport

> > Date: Thursday, July 22, 2010, 8:23 PM

> >

> > Hi Everyone. My husband was diagnosed with prostate cancer 2 weeks ago.

Initially, we were pleased with his urologist - he was very kind and informative

when breaking the news to us. We went to see him last night with some

additional questions. We're leaning towards the robotic surgery. Everything

I've read says the lymph nodes should be removed and biopsied, but he says he

does not do that. I'm truly perplexed by this because how will we know whether

the cancer has spread?

> >

> > A little history (I don't have the exact numbers in front of me):

> >

> > My husbands PSA went from around a 2 - 4 from one year to the next. Then it

jumped from a 4 to 6+. The urologist did not think cancer would cause such a

jump, so he was treated for prostatitis. But after a month on antibiotics, the

PSA did not go down. So a biopsy was done, which showed he had prostate

cancer. Five cores had definitive signs of cancer, one was suspiscious and one

noted chronic prostatitis. The Gleason was a mix of 6's and 7's, with the first

number being a 3 (I think for all or most).

> >

> > I've made an appointment for another urologist for next Wednesday. I also

have an appointment with a surgical oncologist at Fox Chase, but could not get

him in for another 3 weeks. Of course I'm afraid that we are putting things off

too long - I don't want the cancer to spread, but I know we only have one shot

at at least trying to get this right the first time.

> >

> > Not biopsying the lymph nodes causes me a lot of concern. Is that something

that should always be done? The urologist is saying that the cancer isn't

aggressive enough to warrant the removal of the lymph nodes.

> >

> > Any thoughts you can give me on this would be greatly appreciated.

> >

> > Thanks so much!

> >

> > Sandy

> >

> > ------------------------------------

> >

> > There are just two rules for this group

> > 1 No Spam

> > 2 Be kind to others

> >

> > Please recognise that Prostate Cancerhas different guises and needs

different levels of treatment and in some cases no treatment at all. Some men

even with all options offered chose radical options that you would not choose.

We only ask that people be informed before choice is made, we cannot and should

not tell other members what to do, other than look at other options.

> >

> > Try to delete old material that is no longer applying when clicking reply

> > Try to change the title if the content requires it

July 23, 2010

Thanks Mike!

Sandy

> >

> > From: s_l_toth <s_l_toth@>

> > Subject: Is removal of lymph nodes an option?

> > To: ProstateCancerSupport

> > Date: Thursday, July 22, 2010, 8:23 PM

> >

> > Hi Everyone. My husband was diagnosed with prostate cancer 2 weeks ago.

Initially, we were pleased with his urologist - he was very kind and informative

when breaking the news to us. We went to see him last night with some

additional questions. We're leaning towards the robotic surgery. Everything

I've read says the lymph nodes should be removed and biopsied, but he says he

does not do that. I'm truly perplexed by this because how will we know whether

the cancer has spread?

> >

> > A little history (I don't have the exact numbers in front of me):

> >

> > My husbands PSA went from around a 2 - 4 from one year to the next. Then it

jumped from a 4 to 6+. The urologist did not think cancer would cause such a

jump, so he was treated for prostatitis. But after a month on antibiotics, the

PSA did not go down. So a biopsy was done, which showed he had prostate

cancer. Five cores had definitive signs of cancer, one was suspiscious and one

noted chronic prostatitis. The Gleason was a mix of 6's and 7's, with the first

number being a 3 (I think for all or most).

> >

> > I've made an appointment for another urologist for next Wednesday. I also

have an appointment with a surgical oncologist at Fox Chase, but could not get

him in for another 3 weeks. Of course I'm afraid that we are putting things off

too long - I don't want the cancer to spread, but I know we only have one shot

at at least trying to get this right the first time.

> >

> > Not biopsying the lymph nodes causes me a lot of concern. Is that something

that should always be done? The urologist is saying that the cancer isn't

aggressive enough to warrant the removal of the lymph nodes.

> >

> > Any thoughts you can give me on this would be greatly appreciated.

> >

> > Thanks so much!

> >

> > Sandy

> >

> > ------------------------------------

> >

> > There are just two rules for this group

> > 1 No Spam

> > 2 Be kind to others

> >

> > Please recognise that Prostate Cancerhas different guises and needs

different levels of treatment and in some cases no treatment at all. Some men

even with all options offered chose radical options that you would not choose.

We only ask that people be informed before choice is made, we cannot and should

not tell other members what to do, other than look at other options.

> >

> > Try to delete old material that is no longer applying when clicking reply

> > Try to change the title if the content requires it

July 23, 2010

That's good to know - thank you.

Sandy

> >

> > If the surgical treatment option is chosen, biopsy of the lymph node(s) is

an

> > option. If the surgical access method is perineal (behind the rectum), the

> >lymph

> >

> > node is not taken (this method is considered to be relatively old-fashioned,

> >but

> >

> > has healing speed comparable to robotic retropubic surgery). However, with

any

>

> > of the surgical method, the seminal vesicle is removed and studied for

spread.

>

> > Generally if the margins are clean, then lymph node removal is not done. If

> > there is spread past the margins.

> >

> > The need or preference for lymph node biopsy is generally up to the

urologist

> >or

> >

> > urological surgeon.

> >

> > Louis. . . .

> >

> > ________________________________

> > From: s_l_toth <s_l_toth@>

> > To: ProstateCancerSupport

> > Sent: Thu, July 22, 2010 8:23:59 PM

> > Subject: Is removal of lymph nodes an option?

> >

> > Ã‚Â

> > Hi Everyone. My husband was diagnosed with prostate cancer 2 weeks ago.

> > Initially, we were pleased with his urologist - he was very kind and

> >informative

> >

> > when breaking the news to us. We went to see him last night with some

> >additional

> >

> > questions. We're leaning towards the robotic surgery. Everything I've read

says

> >

> > the lymph nodes should be removed and biopsied, but he says he does not do

> >that.

> >

> > I'm truly perplexed by this because how will we know whether the cancer has

> > spread?

> >

> > A little history (I don't have the exact numbers in front of me):

> >

> > My husbands PSA went from around a 2 - 4 from one year to the next. Then it

> > jumped from a 4 to 6+. The urologist did not think cancer would cause such a

> > jump, so he was treated for prostatitis. But after a month on antibiotics,

the

>

> > PSA did not go down. So a biopsy was done, which showed he had prostate

cancer.

> >

> > Five cores had definitive signs of cancer, one was suspiscious and one noted

> > chronic prostatitis. The Gleason was a mix of 6's and 7's, with the first

> >number

> >

> > being a 3 (I think for all or most).

> >

> > I've made an appointment for another urologist for next Wednesday. I also

have

>

> > an appointment with a surgical oncologist at Fox Chase, but could not get

him

> >in

> >

> > for another 3 weeks. Of course I'm afraid that we are putting things off too

> > long - I don't want the cancer to spread, but I know we only have one shot

at

> >at

> >

> > least trying to get this right the first time.

> >

> > Not biopsying the lymph nodes causes me a lot of concern. Is that something

> >that

> >

> > should always be done? The urologist is saying that the cancer isn't

aggressive

> >

> > enough to warrant the removal of the lymph nodes.

> >

> > Any thoughts you can give me on this would be greatly appreciated.

> >

> > Thanks so much!

> >

> > Sandy

> >

>

July 23, 2010

That's good to know - thank you.

Sandy

> >

> > If the surgical treatment option is chosen, biopsy of the lymph node(s) is

an

> > option. If the surgical access method is perineal (behind the rectum), the

> >lymph

> >

> > node is not taken (this method is considered to be relatively old-fashioned,

> >but

> >

> > has healing speed comparable to robotic retropubic surgery). However, with

any

>

> > of the surgical method, the seminal vesicle is removed and studied for

spread.

>

> > Generally if the margins are clean, then lymph node removal is not done. If

> > there is spread past the margins.

> >

> > The need or preference for lymph node biopsy is generally up to the

urologist

> >or

> >

> > urological surgeon.

> >

> > Louis. . . .

> >

> > ________________________________

> > From: s_l_toth <s_l_toth@>

> > To: ProstateCancerSupport

> > Sent: Thu, July 22, 2010 8:23:59 PM

> > Subject: Is removal of lymph nodes an option?

> >

> > Ã‚Â

> > Hi Everyone. My husband was diagnosed with prostate cancer 2 weeks ago.

> > Initially, we were pleased with his urologist - he was very kind and

> >informative

> >

> > when breaking the news to us. We went to see him last night with some

> >additional

> >

> > questions. We're leaning towards the robotic surgery. Everything I've read

says

> >

> > the lymph nodes should be removed and biopsied, but he says he does not do

> >that.

> >

> > I'm truly perplexed by this because how will we know whether the cancer has

> > spread?

> >

> > A little history (I don't have the exact numbers in front of me):

> >

> > My husbands PSA went from around a 2 - 4 from one year to the next. Then it

> > jumped from a 4 to 6+. The urologist did not think cancer would cause such a

> > jump, so he was treated for prostatitis. But after a month on antibiotics,

the

>

> > PSA did not go down. So a biopsy was done, which showed he had prostate

cancer.

> >

> > Five cores had definitive signs of cancer, one was suspiscious and one noted

> > chronic prostatitis. The Gleason was a mix of 6's and 7's, with the first

> >number

> >

> > being a 3 (I think for all or most).

> >

> > I've made an appointment for another urologist for next Wednesday. I also

have

>

> > an appointment with a surgical oncologist at Fox Chase, but could not get

him

> >in

> >

> > for another 3 weeks. Of course I'm afraid that we are putting things off too

> > long - I don't want the cancer to spread, but I know we only have one shot

at

> >at

> >

> > least trying to get this right the first time.

> >

> > Not biopsying the lymph nodes causes me a lot of concern. Is that something

> >that

> >

> > should always be done? The urologist is saying that the cancer isn't

aggressive

> >

> > enough to warrant the removal of the lymph nodes.

> >

> > Any thoughts you can give me on this would be greatly appreciated.

> >

> > Thanks so much!

> >

> > Sandy

> >

>

July 23, 2010

Hi Lynn. A friend of mine that had breast cancer has the same problem - I think

it's called lymphadema. She has to wear the pressure bandage. I guess removing

the lymph nodes can cause some problems - it's just to me, it seems like it's a

good way of checking to see if the cancer has spread. Well, at least we're

getting another opinion which will help us understand all this.

Sandy

> > >

> > > If the surgical treatment option is chosen, biopsy of the lymph node(s) is

an

> > > option. If the surgical access method is perineal (behind the rectum), the

lymph

> > > node is not taken (this method is considered to be relatively

old-fashioned, but

> > > has healing speed comparable to robotic retropubic surgery). However, with

any

> > > of the surgical method, the seminal vesicle is removed and studied for

spread.

> > > Generally if the margins are clean, then lymph node removal is not done.

If

> > > there is spread past the margins.

> > >

> > > The need or preference for lymph node biopsy is generally up to the

urologist or

> > > urological surgeon.

> > >

> > > Louis. . . .

> > >

> > > ________________________________

> > > From: s_l_toth <s_l_toth@>

> > > To: ProstateCancerSupport

<mailto:ProstateCancerSupport%40yahoogroups.com>

> > > Sent: Thu, July 22, 2010 8:23:59 PM

> > > Subject: Is removal of lymph nodes an option?

> > >

> > > Ã‚

> > > Hi Everyone. My husband was diagnosed with prostate cancer 2 weeks ago.

> > > Initially, we were pleased with his urologist - he was very kind and

informative

> > > when breaking the news to us. We went to see him last night with some

additional

> > > questions. We're leaning towards the robotic surgery. Everything I've read

says

> > > the lymph nodes should be removed and biopsied, but he says he does not do

that.

> > > I'm truly perplexed by this because how will we know whether the cancer

has

> > > spread?

> > >

> > > A little history (I don't have the exact numbers in front of me):

> > >

> > > My husbands PSA went from around a 2 - 4 from one year to the next. Then

it

> > > jumped from a 4 to 6+. The urologist did not think cancer would cause such

a

> > > jump, so he was treated for prostatitis. But after a month on antibiotics,

the

> > > PSA did not go down. So a biopsy was done, which showed he had prostate

cancer.

> > > Five cores had definitive signs of cancer, one was suspiscious and one

noted

> > > chronic prostatitis. The Gleason was a mix of 6's and 7's, with the first

number

> > > being a 3 (I think for all or most).

> > >

> > > I've made an appointment for another urologist for next Wednesday. I also

have

> > > an appointment with a surgical oncologist at Fox Chase, but could not get

him in

> > > for another 3 weeks. Of course I'm afraid that we are putting things off

too

> > > long - I don't want the cancer to spread, but I know we only have one shot

at at

> > > least trying to get this right the first time.

> > >

> > > Not biopsying the lymph nodes causes me a lot of concern. Is that

something that

> > > should always be done? The urologist is saying that the cancer isn't

aggressive

> > > enough to warrant the removal of the lymph nodes.

> > >

> > > Any thoughts you can give me on this would be greatly appreciated.

> > >

> > > Thanks so much!

> > >

> > > Sandy

> > >

> >

> > No virus found in this incoming message.

> > Checked by AVG - www.avg.com

> > Version: 9.0.851 / Virus Database: 271.1.1/3023 - Release Date: 07/23/10

01:36:00

> >

>

July 23, 2010

Hi Lynn. A friend of mine that had breast cancer has the same problem - I think

it's called lymphadema. She has to wear the pressure bandage. I guess removing

the lymph nodes can cause some problems - it's just to me, it seems like it's a

good way of checking to see if the cancer has spread. Well, at least we're

getting another opinion which will help us understand all this.

Sandy

> > >

> > > If the surgical treatment option is chosen, biopsy of the lymph node(s) is

an

> > > option. If the surgical access method is perineal (behind the rectum), the

lymph

> > > node is not taken (this method is considered to be relatively

old-fashioned, but

> > > has healing speed comparable to robotic retropubic surgery). However, with

any

> > > of the surgical method, the seminal vesicle is removed and studied for

spread.

> > > Generally if the margins are clean, then lymph node removal is not done.

If

> > > there is spread past the margins.

> > >

> > > The need or preference for lymph node biopsy is generally up to the

urologist or

> > > urological surgeon.

> > >

> > > Louis. . . .

> > >

> > > ________________________________

> > > From: s_l_toth <s_l_toth@>

> > > To: ProstateCancerSupport

<mailto:ProstateCancerSupport%40yahoogroups.com>

> > > Sent: Thu, July 22, 2010 8:23:59 PM

> > > Subject: Is removal of lymph nodes an option?

> > >

> > > Ã‚

> > > Hi Everyone. My husband was diagnosed with prostate cancer 2 weeks ago.

> > > Initially, we were pleased with his urologist - he was very kind and

informative

> > > when breaking the news to us. We went to see him last night with some

additional

> > > questions. We're leaning towards the robotic surgery. Everything I've read

says

> > > the lymph nodes should be removed and biopsied, but he says he does not do

that.

> > > I'm truly perplexed by this because how will we know whether the cancer

has

> > > spread?

> > >

> > > A little history (I don't have the exact numbers in front of me):

> > >

> > > My husbands PSA went from around a 2 - 4 from one year to the next. Then

it

> > > jumped from a 4 to 6+. The urologist did not think cancer would cause such

a

> > > jump, so he was treated for prostatitis. But after a month on antibiotics,

the

> > > PSA did not go down. So a biopsy was done, which showed he had prostate

cancer.

> > > Five cores had definitive signs of cancer, one was suspiscious and one

noted

> > > chronic prostatitis. The Gleason was a mix of 6's and 7's, with the first

number

> > > being a 3 (I think for all or most).

> > >

> > > I've made an appointment for another urologist for next Wednesday. I also

have

> > > an appointment with a surgical oncologist at Fox Chase, but could not get

him in

> > > for another 3 weeks. Of course I'm afraid that we are putting things off

too

> > > long - I don't want the cancer to spread, but I know we only have one shot

at at

> > > least trying to get this right the first time.

> > >

> > > Not biopsying the lymph nodes causes me a lot of concern. Is that

something that

> > > should always be done? The urologist is saying that the cancer isn't

aggressive

> > > enough to warrant the removal of the lymph nodes.

> > >

> > > Any thoughts you can give me on this would be greatly appreciated.

> > >

> > > Thanks so much!

> > >

> > > Sandy

> > >

> >

> > No virus found in this incoming message.

> > Checked by AVG - www.avg.com

> > Version: 9.0.851 / Virus Database: 271.1.1/3023 - Release Date: 07/23/10

01:36:00

> >

>

July 23, 2010

Removing the lymph nodes is an option of

the surgeon. Typically they don’t remove all of them since it can

be difficult to find all of them. More usual is they will take out a couple and

send them to pathology with the rest of the tissue removed. The lymph

node biopsy typically will add on about 30 minutes to the surgery. At

least for robotic surgery. Most surgeon won’t do this unless there

is a suspicion that the cancer has spread outside the prostate envelope.

From the sounds of your husband’s situation you have caught the cancer in

the early stages and a lymp node biopsy may not be warranted. (FYI I am not a

medical doctor).

Prostate cancer is typically a slow

growing cancer and you have caught it early enough you do have some time to

explore your options. Do your research (like you are doing now) and get

your second and third opinions. Make sure you talk with a Urologist

(surgery), Oncologist (radiation) and Medical Oncologist (Chemo and others).

I did have surgery and did have my lymph

nodes biopsied but I have a much more aggressive and advanced cancer (Gleason 9

with perineural invasion and all samples showed signs of cancer), I did

have positive margins outside the prostate but my lymph nodes came back as

negative. I am now going through radiation to treat the cancer in the

pelvic area. During discussions with my Oncologist we talked about

radiating my lymph nodes. The biggest concern was; is treating the lymph

nodes worth the side effects from the radiation. Comparing my case with

your husband’s doesn’t surprise me the doctors don’t want to

effect the lymph nodes yet.

PS I read in an older article on

prostate cancer they used to biopsy the lymph nodes first before beginning the

prostectomy. The thought was if the lymph nodes were invaded then surgery

wasn’t going to help. I think advances in PC detection has made

this more obsolete.

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of s_l_toth

Sent: Thursday, July 22, 2010 8:24

PM

To: ProstateCancerSupport

Subject:

Is removal of lymph nodes an option?

Hi Everyone. My husband was diagnosed with prostate

cancer 2 weeks ago. Initially, we were pleased with his urologist - he was very

kind and informative when breaking the news to us. We went to see him last

night with some additional questions. We're leaning towards the robotic

surgery. Everything I've read says the lymph nodes should be removed and

biopsied, but he says he does not do that. I'm truly perplexed by this because

how will we know whether the cancer has spread?

A little history (I don't have the exact numbers in front of me):

My husbands PSA went from around a 2 - 4 from one year to the next. Then it

jumped from a 4 to 6+. The urologist did not think cancer would cause such a

jump, so he was treated for prostatitis. But after a month on antibiotics, the

PSA did not go down. So a biopsy was done, which showed he had prostate cancer.

Five cores had definitive signs of cancer, one was suspiscious and one noted

chronic prostatitis. The Gleason was a mix of 6's and 7's, with the first

number being a 3 (I think for all or most).

I've made an appointment for another urologist for next Wednesday. I also have

an appointment with a surgical oncologist at Fox Chase, but could not get him

in for another 3 weeks. Of course I'm afraid that we are putting things off too

long - I don't want the cancer to spread, but I know we only have one shot at

at least trying to get this right the first time.

Not biopsying the lymph nodes causes me a lot of concern. Is that something

that should always be done? The urologist is saying that the cancer isn't

aggressive enough to warrant the removal of the lymph nodes.

Any thoughts you can give me on this would be greatly appreciated.

Thanks so much!

Sandy

July 25, 2010

Thanks Steve. I appreciate all of the information - I am particularly

interested in having the biopsy slides re-evaluated, so I need to look into

that. We have an appointment with Fox Chase Cancer Center in a couple of weeks,

I wonder if they do that or if I should do that prior to our appointment.

I must admit I really would like a second opinion on the bioplsy slides because

it looks to me like the lab that performed the biopsy of the specimens is owned

by the urology practice that my husband went to.

We did get a couple of books but not the one by Dr. Strum - I'll have to check

that out.

Thanks again for the info.

Sandy

> > > >

> > > > From: s_l_toth <s_l_toth@>

> > > > Subject: Is removal of lymph nodes

> > an option?

> > > > To: ProstateCancerSupport

> > <mailto:ProstateCancerSupport%40yahoogroups.com>

> > > > Date: Thursday, July 22, 2010, 8:23 PM

> > > >

> > > > Hi Everyone. My husband was diagnosed with prostate cancer

> > 2 weeks ago. Initially, we were pleased with his urologist - he

> > was very kind and informative when breaking the news to us. We

> > went to see him last night with some additional questions. We're

> > leaning towards the robotic surgery. Everything I've read says

> > the lymph nodes should be removed and biopsied, but he says he

> > does not do that. I'm truly perplexed by this because how will

> > we know whether the cancer has spread?

> > > >

> > > > A little history (I don't have the exact numbers in front of

> > me):

> > > >

> > > > My husbands PSA went from around a 2 - 4 from one year to

> > the next. Then it jumped from a 4 to 6+. The urologist did not

> > think cancer would cause such a jump, so he was treated for

> > prostatitis. But after a month on antibiotics, the PSA did not

> > go down. So a biopsy was done, which showed he had prostate

> > cancer. Five cores had definitive signs of cancer, one was

> > suspiscious and one noted chronic prostatitis. The Gleason was a

> > mix of 6's and 7's, with the first number being a 3 (I think for

> > all or most).

> > > >

> > > > I've made an appointment for another urologist for next

> > Wednesday. I also have an appointment with a surgical oncologist

> > at Fox Chase, but could not get him in for another 3 weeks. Of

> > course I'm afraid that we are putting things off too long - I

> > don't want the cancer to spread, but I know we only have one shot

> > at at least trying to get this right the first time.

> > > >

> > > > Not biopsying the lymph nodes causes me a lot of concern.

> > Is that something that should always be done? The urologist is

> > saying that the cancer isn't aggressive enough to warrant the

> > removal of the lymph nodes.

> > > >

> > > > Any thoughts you can give me on this would be greatly

> > appreciated.

> > > >

> > > > Thanks so much!

> > > >

> > > > Sandy

> > > >

> > > > ------------------------------------

> > > >

> > > > There are just two rules for this group

> > > > 1 No Spam

> > > > 2 Be kind to others

> > > >

> > > > Please recognise that Prostate Cancerhas different guises

> > and needs different levels of treatment and in some cases no

> > treatment at all. Some men even with all options offered chose

> > radical options that you would not choose. We only ask that

> > people be informed before choice is made, we cannot and should

> > not tell other members what to do, other than look at other options.

> > > >

> > > > Try to delete old material that is no longer applying when

> > clicking reply

> > > > Try to change the title if the content requires it Yahoo!

> > Groups Links

> > > >

> > >

> > > ------------------------------------

> > >

> > > There are just two rules for this group

> > > 1 No Spam

> > > 2 Be kind to others

> > >

> > > Please recognise that Prostate Cancerhas different guises and

> > needs different levels of treatment and in some cases no

> > treatment at all. Some men even with all options offered chose

> > radical options that you would not choose. We only ask that

> > people be informed before choice is made, we cannot and should

> > not tell other members what to do, other than look at other options.

> > >

> > > Try to delete old material that is no longer applying when

> > clicking reply

> > > Try to change the title if the content requires it Yahoo!

> > Groups Links

> > >

> >

>

July 25, 2010

Hi Larry. Thank you for sharing that information. I wish you the best with

your treatment.

One of the most common things I've seen is that the patient should do a lot of

research. The first urologist/surgeon we saw seemed like he did not encourage

us to do our own research. Although he was supportive of us getting a 2nd

opinion when he sensed we weren't satisified with his reponses.

When we first got the news, we wanted to rush headlong into just having the

surgery done. We've calmed down enough to at least try to gather more

information and hopefully make the best decision regarding tretament.

Thanks again!

Sandy

>

> Removing the lymph nodes is an option of the surgeon. Typically they don't

> remove all of them since it can be difficult to find all of them. More usual

> is they will take out a couple and send them to pathology with the rest of

> the tissue removed. The lymph node biopsy typically will add on about 30

> minutes to the surgery. At least for robotic surgery. Most surgeon won't

> do this unless there is a suspicion that the cancer has spread outside the

> prostate envelope. From the sounds of your husband's situation you have

> caught the cancer in the early stages and a lymp node biopsy may not be

> warranted. (FYI I am not a medical doctor).

>

> Prostate cancer is typically a slow growing cancer and you have caught it

> early enough you do have some time to explore your options. Do your

> research (like you are doing now) and get your second and third opinions.

> Make sure you talk with a Urologist (surgery), Oncologist (radiation) and

> Medical Oncologist (Chemo and others).

>

> I did have surgery and did have my lymph nodes biopsied but I have a much

> more aggressive and advanced cancer (Gleason 9 with perineural invasion and

> all samples showed signs of cancer), I did have positive margins outside

> the prostate but my lymph nodes came back as negative. I am now going

> through radiation to treat the cancer in the pelvic area. During

> discussions with my Oncologist we talked about radiating my lymph nodes.

> The biggest concern was; is treating the lymph nodes worth the side effects

> from the radiation. Comparing my case with your husband's doesn't surprise

> me the doctors don't want to effect the lymph nodes yet.

>

> PS I read in an older article on prostate cancer they used to biopsy the

> lymph nodes first before beginning the prostectomy. The thought was if the

> lymph nodes were invaded then surgery wasn't going to help. I think

> advances in PC detection has made this more obsolete.

>

> _____

>

> From: ProstateCancerSupport

> [mailto:ProstateCancerSupport ] On Behalf Of s_l_toth

> Sent: Thursday, July 22, 2010 8:24 PM

> To: ProstateCancerSupport

> Subject: Is removal of lymph nodes an option?

>

> Hi Everyone. My husband was diagnosed with prostate cancer 2 weeks ago.

> Initially, we were pleased with his urologist - he was very kind and

> informative when breaking the news to us. We went to see him last night with

> some additional questions. We're leaning towards the robotic surgery.

> Everything I've read says the lymph nodes should be removed and biopsied,

> but he says he does not do that. I'm truly perplexed by this because how

> will we know whether the cancer has spread?

>

> A little history (I don't have the exact numbers in front of me):

>

> My husbands PSA went from around a 2 - 4 from one year to the next. Then it

> jumped from a 4 to 6+. The urologist did not think cancer would cause such a

> jump, so he was treated for prostatitis. But after a month on antibiotics,

> the PSA did not go down. So a biopsy was done, which showed he had prostate

> cancer. Five cores had definitive signs of cancer, one was suspiscious and

> one noted chronic prostatitis. The Gleason was a mix of 6's and 7's, with

> the first number being a 3 (I think for all or most).

>

> I've made an appointment for another urologist for next Wednesday. I also

> have an appointment with a surgical oncologist at Fox Chase, but could not

> get him in for another 3 weeks. Of course I'm afraid that we are putting

> things off too long - I don't want the cancer to spread, but I know we only

> have one shot at at least trying to get this right the first time.

>

> Not biopsying the lymph nodes causes me a lot of concern. Is that something

> that should always be done? The urologist is saying that the cancer isn't

> aggressive enough to warrant the removal of the lymph nodes.

>

> Any thoughts you can give me on this would be greatly appreciated.

>

> Thanks so much!

>

> Sandy

>

July 29, 2010

Hi Alan. I have to say, so far I am very happy with Fox Chase. No sooner had

the appointment been clarified did I receive a call asking to have the slides

sent to their pathology department. In addition, they wanted CDs of the actual

bone scan and CT scan as well as any other blood tests, reports that we had. I

like that they will have all this information for review before our appointment.

Thanks for your post!

Sandy

> > > > > >

> > > > > > From: s_l_toth <s_l_toth@>

> > > > > > Subject: Is removal of lymph nodes

> > > > an option?

> > > > > > To: ProstateCancerSupport

> > > > <mailto:ProstateCancerSupport%40yahoogroups.com>

> > > > > > Date: Thursday, July 22, 2010, 8:23 PM

> > > > > >

> > > > > > Hi Everyone. My husband was diagnosed with prostate cancer

> > > > 2 weeks ago. Initially, we were pleased with his urologist - he

> > > > was very kind and informative when breaking the news to us. We

> > > > went to see him last night with some additional questions. We're

> > > > leaning towards the robotic surgery. Everything I've read says

> > > > the lymph nodes should be removed and biopsied, but he says he

> > > > does not do that. I'm truly perplexed by this because how will

> > > > we know whether the cancer has spread?

> > > > > >

> > > > > > A little history (I don't have the exact numbers in front of

> > > > me):

> > > > > >

> > > > > > My husbands PSA went from around a 2 - 4 from one year to

> > > > the next. Then it jumped from a 4 to 6+. The urologist did not

> > > > think cancer would cause such a jump, so he was treated for

> > > > prostatitis. But after a month on antibiotics, the PSA did not

> > > > go down. So a biopsy was done, which showed he had prostate

> > > > cancer. Five cores had definitive signs of cancer, one was

> > > > suspiscious and one noted chronic prostatitis. The Gleason was a

> > > > mix of 6's and 7's, with the first number being a 3 (I think for

> > > > all or most).

> > > > > >

> > > > > > I've made an appointment for another urologist for next

> > > > Wednesday. I also have an appointment with a surgical oncologist

> > > > at Fox Chase, but could not get him in for another 3 weeks. Of

> > > > course I'm afraid that we are putting things off too long - I

> > > > don't want the cancer to spread, but I know we only have one shot

> > > > at at least trying to get this right the first time.

> > > > > >

> > > > > > Not biopsying the lymph nodes causes me a lot of concern.

> > > > Is that something that should always be done? The urologist is

> > > > saying that the cancer isn't aggressive enough to warrant the

> > > > removal of the lymph nodes.

> > > > > >

> > > > > > Any thoughts you can give me on this would be greatly

> > > > appreciated.

> > > > > >

> > > > > > Thanks so much!

> > > > > >

> > > > > > Sandy

> > > > > >

> > > > > > ------------------------------------

> > > > > >

> > > > > > There are just two rules for this group

> > > > > > 1 No Spam

> > > > > > 2 Be kind to others

> > > > > >

> > > > > > Please recognise that Prostate Cancerhas different guises

> > > > and needs different levels of treatment and in some cases no

> > > > treatment at all. Some men even with all options offered chose

> > > > radical options that you would not choose. We only ask that

> > > > people be informed before choice is made, we cannot and should

> > > > not tell other members what to do, other than look at other options.

> > > > > >

> > > > > > Try to delete old material that is no longer applying when

> > > > clicking reply

> > > > > > Try to change the title if the content requires it Yahoo!

> > > > Groups Links

> > > > > >

> > > > >

> > > > > ------------------------------------

> > > > >

> > > > > There are just two rules for this group

> > > > > 1 No Spam

> > > > > 2 Be kind to others

> > > > >

> > > > > Please recognise that Prostate Cancerhas different guises and

> > > > needs different levels of treatment and in some cases no

> > > > treatment at all. Some men even with all options offered chose

> > > > radical options that you would not choose. We only ask that

> > > > people be informed before choice is made, we cannot and should

> > > > not tell other members what to do, other than look at other options.

> > > > >

> > > > > Try to delete old material that is no longer applying when

> > > > clicking reply

> > > > > Try to change the title if the content requires it Yahoo!

> > > > Groups Links

> > > > >

> > > >

> > >

> >

> > ------------------------------------

> >

> > There are just two rules for this group

> > 1 No Spam

> > 2 Be kind to others

> >

> > Please recognise that Prostate Cancerhas different guises and needs

different

> >levels of treatment and in some cases no treatment at all. Some men even

with

> >all options offered chose radical options that you would not choose. We only

> >ask that people be informed before choice is made, we cannot and should not

> >tell other members what to do, other than look at other options.

> >

> > Try to delete old material that is no longer applying when clicking reply

> > Try to change the title if the content requires it Yahoo! Groups Links

> >

>

July 29, 2010

Hi Jim. I wish you the best of luck with your treatment. I can certainly

understand not wanting surgery. It is good that there are several treatment

options available for prostate cancer.

Thanks for your post.

Sandy

> >

> > Removing the lymph nodes is an option of the surgeon. Typically they don't

> > remove all of them since it can be difficult to find all of them. More usual

> > is they will take out a couple and send them to pathology with the rest of

> > the tissue removed. The lymph node biopsy typically will add on about 30

> > minutes to the surgery. At least for robotic surgery. Most surgeon won't

> > do this unless there is a suspicion that the cancer has spread outside the

> > prostate envelope. From the sounds of your husband's situation you have

> > caught the cancer in the early stages and a lymp node biopsy may not be

> > warranted. (FYI I am not a medical doctor).

> >

> > Prostate cancer is typically a slow growing cancer and you have caught it

> > early enough you do have some time to explore your options. Do your

> > research (like you are doing now) and get your second and third opinions.

> > Make sure you talk with a Urologist (surgery), Oncologist (radiation) and

> > Medical Oncologist (Chemo and others).

> >

> > I did have surgery and did have my lymph nodes biopsied but I have a much

> > more aggressive and advanced cancer (Gleason 9 with perineural invasion and

> > all samples showed signs of cancer), I did have positive margins outside

> > the prostate but my lymph nodes came back as negative. I am now going

> > through radiation to treat the cancer in the pelvic area. During

> > discussions with my Oncologist we talked about radiating my lymph nodes.

> > The biggest concern was; is treating the lymph nodes worth the side effects

> > from the radiation. Comparing my case with your husband's doesn't surprise

> > me the doctors don't want to effect the lymph nodes yet.

> >

> > PS I read in an older article on prostate cancer they used to biopsy the

> > lymph nodes first before beginning the prostectomy. The thought was if the

> > lymph nodes were invaded then surgery wasn't going to help. I think

> > advances in PC detection has made this more obsolete.

> >

> > _____

> >

> > From: ProstateCancerSupport

> > [mailto:ProstateCancerSupport ] On Behalf Of s_l_toth

> > Sent: Thursday, July 22, 2010 8:24 PM

> > To: ProstateCancerSupport

> > Subject: Is removal of lymph nodes an option?

> >

> > Hi Everyone. My husband was diagnosed with prostate cancer 2 weeks ago.

> > Initially, we were pleased with his urologist - he was very kind and

> > informative when breaking the news to us. We went to see him last night with

> > some additional questions. We're leaning towards the robotic surgery.

> > Everything I've read says the lymph nodes should be removed and biopsied,

> > but he says he does not do that. I'm truly perplexed by this because how

> > will we know whether the cancer has spread?

> >

> > A little history (I don't have the exact numbers in front of me):

> >

> > My husbands PSA went from around a 2 - 4 from one year to the next. Then it

> > jumped from a 4 to 6+. The urologist did not think cancer would cause such a

> > jump, so he was treated for prostatitis. But after a month on antibiotics,

> > the PSA did not go down. So a biopsy was done, which showed he had prostate

> > cancer. Five cores had definitive signs of cancer, one was suspiscious and

> > one noted chronic prostatitis. The Gleason was a mix of 6's and 7's, with

> > the first number being a 3 (I think for all or most).

> >

> > I've made an appointment for another urologist for next Wednesday. I also

> > have an appointment with a surgical oncologist at Fox Chase, but could not

> > get him in for another 3 weeks. Of course I'm afraid that we are putting

> > things off too long - I don't want the cancer to spread, but I know we only

> > have one shot at at least trying to get this right the first time.

> >

> > Not biopsying the lymph nodes causes me a lot of concern. Is that something

> > that should always be done? The urologist is saying that the cancer isn't

> > aggressive enough to warrant the removal of the lymph nodes.

> >

> > Any thoughts you can give me on this would be greatly appreciated.

> >

> > Thanks so much!

> >

> > Sandy

> >

>

July 29, 2010

Thanks Larry. We felt the same way about surgery at first. And we are still

leaning towards the surgery. But we have now seen 2 surgeons and will see a

third at Fox Chase in a couple of weeks. We also spoke with a radiologist.

When we had only seen one surgeon, and he said things we liked to hear (as you

mentioned), we were almost ready to sign on the dotted line. But then we

started going over the conversation with him and realized we had to get more

than one opinion, and I'm glad we did.

I really appreciate everyone's sharing their experiences with me - it's really

helped us so much in deciding to get more opinions.

Thanks again!

Sandy

>

> We ended up going with a 3 opinions after initial diagnosis and took those

> opinions to my GP and a couple of other knowledgeable people before making

> decisions on which treatments and doctor(s) to go with. My wife still

> confers with some of the initial doctors about their opinions as we continue

> on our journey. When choosing a therapy path make sure you are not just

> talking to doctors waiting for one of them to say something you want to

> hear. What you want is to return to the best health with side effects that

> you are willing to live with. I am also surprised at how certain side

> effects that were a big issue are not so important now.

>

> With my aggressive cancer like I almost jumped at the surgery. I then

> calmed down and took the time to research and get other opinions so I knew

> where I was going and what I had to do.

>

> _____

>

> From: ProstateCancerSupport

> [mailto:ProstateCancerSupport ] On Behalf Of s_l_toth

> Sent: Sunday, July 25, 2010 11:23 AM

> To: ProstateCancerSupport

> Subject: Re: Is removal of lymph nodes an option?

>

> Hi Larry. Thank you for sharing that information. I wish you the best with

> your treatment.

>

> One of the most common things I've seen is that the patient should do a lot

> of research. The first urologist/surgeon we saw seemed like he did not

> encourage us to do our own research. Although he was supportive of us

> getting a 2nd opinion when he sensed we weren't satisified with his

> reponses.

>

> When we first got the news, we wanted to rush headlong into just having the

> surgery done. We've calmed down enough to at least try to gather more

> information and hopefully make the best decision regarding tretament.

>

> Thanks again!

>

> Sandy

>

July 31, 2010

Thanks Alan!

Sandy

>

> > Hi Alan. I have to say, so far I am very happy with Fox Chase.

> > No sooner had the appointment been clarified did I receive a

> > call asking to have the slides sent to their pathology

> > department. In addition, they wanted CDs of the actual bone

> > scan and CT scan as well as any other blood tests, reports that

> > we had. I like that they will have all this information for

> > review before our appointment.

>

> The National Cancer Institute has designated a total of 40

> hospitals in the United States as " Comprehensive Cancer Centers " .

> That's NCI's highest rating for a hospital for cancer treatment.

> With only 40 in the country, many states don't have even one.

> Pennsylvania has three.

>

> I think there are a lot of hospitals that aren't on NCI's list

> that still give excellent care, but I should think you can't

> really do any better than Fox Chase. It's rated right up there

> with MD , Sloan-Kettering, s Hopkins, the Mayo

> Clinic, etc.

>

> You should be in good hands there. Best of luck with them.

>

> Alan

>

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