Recurrence in lymph nodes after prostatectomy

[steve_parrett]

My father underwent robotic surgery at the Royal Marsden in November 2015 - he's had his 6 week check up and the cancer has spread to lymph nodes. I thought these lymph nodes were supposed to be removed during prostatectomy but I'm not sure how many were (if any).

What now? Does he undergo surgery again? What's the prognosis like in this situation? Thanks for any advice, just when we thought it was all over and done with.

[professoreden]

Hi and I'm sorry to read about your father's problem. I assume that you meant 6 month (rather than 6 week) check as November 2015 was 6 months ago and that he's had some form of imaging that shows nodal recurrence, such as a CT, MRI or PET CT scan, which followed an elevated PSA level.

Depending on cancer parameters, the European Association of Urology advises either no lymph node removal at the time of prostatectomy (low-risk patients i.e. those with a PSA less than 10 ng/ml, Gleason 3+3 and a tumour that either can't be felt or feels as though it is confined to only one side of the gland) or an extended lymph node removal. I don't know the policy at individual hospitals (and wouldn't comment on them even if I did) but there is a recognised worldwide association between the use of keyhole surgery and the tendency to either omit lymph node removal altogether or to only remove a limited number of nodes http://www.europeanurology.com/article/S0302-2838(14)00421-7/fulltext/more-extensive-pelvic-lymph-node-dissection-improves-survival-in-patients-with-node-positive-prostate-cancer. This can increase the likelihood of nodal recurrence following prostatectomy but even if an extended lymph node removal is done, recurrence in the lymph nodes can occur because it is impossible to remove every lymph node in the body that the prostate drains to, although it is less likely to occur after an extended removal.

Assuming your father's scans only show lymph node recurrence in the pelvis he would be suitable for salvage lymphadenectomy (lymph node removal), pelvic radiotherapy, hormonal therapy with or without chemotherapy or observation alone. Depending on the number and location of nodes involved, the prognosis can be very good but generally lymph node involvement is not good news as you already clearly understand.

Feel free to re-post on this forum as you/your father receive more information/advice.