Treating Lymph Node
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- Опубліковано 17 лют 2024
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0:23 What are lymph nodes, and where are they in the body, relative to the prostate gland?
1:49 How are different degrees of lymph node metastasis usually treated?
4:30 Is there a likelihood of metastasis associated with each Gleason score?
6:06 Can Gleason grade indicate the location of a potential metastasis?
6:46 How many metastatic lymph nodes constitutes a "serious" metastatic condition?
8:57 Is a specific form of radiation more effective for treating metastatic lymph nodes?
10:06 Could radiation potentially damage tissues near the lymph nodes during treatment?
11:22 What should a previously treated patient who discovers new metastasis do?
13:17 What should a post-surgery patient with just one abdominal metastasis do?
14:26 Can metastasis in the chest or neck lymph nodes be treated with radiation?
16:17 What differentiates lymph node metastasis from bone metastasis?
17:48 Alex's conclusions
18:20 If you need help
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Very useful information
Six years ago, I had the standard radiation for my 4+3 rated prostate cancer...about a year ago, my post-radiation PSA began to move up, after being down to near zero...after three readings moving upwards, to just under 2.0, My oncologist did a PSMA PET scan, and two lymph nodes did light up, although dimly. So, I had three doses of Stereotactic radiation...very precise aiming right at the two small areas of lymph node cancer. My doctor says I have at least a 90% chance of total success! He will be checking my PSA levels in the oncoming months and he expects those levels to move back down. That PSMA pet scan is a fantastic step forwards, in spotting tumors!...I was actually scanned from my head to my knees, with no reactions to the isotope, except for those two lymph nodes. Amazing technology!
Put an https : // www in front of this
ncbi.nlm.nih.gov/pmc/articles/PMC9436997
Happy to hear your improvement and the success with the PET PSMA scan. Was your initial treatment radiation only or was that after surgery removal plus radiation?
My case is similar. 10.5 PSA, 4+3 Gleason, .46 decipher genome score, moved into left seminal vesical and have two tiny PSMA spots on my left lower lymph nodes according to a PSMA PET Scan. The radiologist said they are so small that they would not have shown up on a MRI which you probably had six years ago before PSMA scans came out. The new PSMA PET Scans are remarkable. I'm undergoing hormone treatment and 28 weeks radiation. They tell me that my PC may be curable, but only time will tell.
@@derickdevindavis I was offered the decision to go either way..surgery, or radiation...I chose radiation...44 hits of standard radiation. It was the right decision for me.
@@terranceolson9134 PSMA Pet scans are the increasing way to go!...my insurance will only cover 80%, so I am faced with over $3 grand owed to the Hospital!...The costs involved are obscene, and must come down, as most folks these days do not have the ability to throw large sums of residual payments around!
An excellent and very topical reference video from professionals. I really appreciate this video and the information imparted.
Thanks again! Very informative!
Very helpful. Thanks!❤
That was a helpful video thank you for doing it i am going to Sylvester cancer Institute at UM of miami Florida i have been treated in the prostate and 1 5mm spot in lymph node . I did a psma after 6 months of treatment with trelstar my doctor says stop for 3 months and see what happens the side affects are terrible from hormone injections . Your videos have been so helpful in my treatment
I have referred these videos to endless amount of people thank you again
Thank you 😊 🙏
So helpful. Thanks for everything you do here.
So good to get this information, very helpful, thank you.
Excellent presentation as always, your information helps so many understand, act, and cope.
Thanks ever so much for these informative videos ,have helped me on my journey through this disease.Keep up the good work 😊
Thank you! I’ll ask my oncologist about combining treatments for the next round of ADT in May, 2024.
I do enjoy these videos. I have a case that I’ve not yet seen. I was diagnosed 2 years ago. Stage 4 with about 5 lymph nodes involved. My PSA at that time was 7.2. I was immediately put on ADT therapy…(Lupron/Zytiga/Prednisone). Within 7 months my PSA was undetectable. It has remained that way ever since. I’m scheduled to be on this treatment for another year (3 years total). It’s been rough but, I’ve managed the side effects pretty well. Diet changes and working out 3 times a week. I have never had any radiation. My oncologist seems to be hesitant because of the side effects which can be worse than what I’m currently experiencing (minimal). I was thinking of asking for another PSMA Pet Scan before going on the “holiday” next year….provided my numbers remain undetectable. I just don’t know at this point if radiation should be required.
I've been binge watching these type of videos. My PSA is 5.56 and I had an MRI last week. Won't know the results until March seventh when I will see my urologist. I have a UTI at present (now on antibiotics) and possibly had one the last time I had PSA checked, which could have some bearing on the level itself. I'm hoping and praying that's all it is. I'm seventy two. Still virile and can have intercourse. Hate to ever lose that precious gift. I will get another PSA test tomorrow by my GP.
Get a psma scan
They did not offer them a few years ago it found cancer in my lymph node
Terry, My PSA increased from less than 2 to 5.7 over about a decade. I fortunately had a urologist who wasn’t eager to rush to do invasive procedures too early. After another 3 years of surveillance (at age 66) my PSA had doubled to about 12, at which time MRI and biopsies were performed and I was diagnosed with localized Gleason 3+4 cancer. I chose IMRT treatment with a 3-month course of Lupron preceding IMRT. Two years later, so far so good and no lingering side effects. PSMA was just becoming a diagnostic tool when I was treated. Now, if my PSA ever rises “too much / too fast” I would definitely want a PSMA scan to help determine what’s up. My main message is: be informed and vigilant but do not feel rushed to decide about invasive diagnostic procedures. And if you eventually decide that you need treatment, certainly do not be persuaded to have a prostatectomy until you have a consultation with a radiation oncologist. And of course, continue to devour the content of this excellent channel!
Thank you for another informative video. I took a calculated risk, about a year before the PSMA was approved in the US, and went off ADT to use the axumin scan to see why my psa was trying to double in a month. The cancer was found to be in lymph nodes at the edge of previous radiation. I had radiation again in May of 2022. I was supposed to stay on the prednisone, zytiga, lupron triple play for 2 years. What I suspect is long covid sucked the life out of me and I stopped in November of 2023 as I had given up on life because I had no enegy left. I used to run and running would offset the fatigue, now it makes the fatigue worse. I have lost not only a way to regain energy but good mental medicine as well. I felt the lupron shot go away second week of November. I was hoping that we got the last of the cancer and it would be curative but I knew it was not guaranteed.
In December my PSA was less than 0.01, in Jan it was 0.12, this month Feb it was 0.21. I don't know how fast is normal but this seems like what I have experienced the two other times I stopped ADT and I have become disapointed with this. I'm concerned because a positive attitude is what I think is my biggest tool against this monster and I'm struggling to stay positive.
What I expect the oncologists to do going forward is a PSMA or another Axumin scan when my psa increases enough. What I have realized over the weekend (I learned of my 0.21 on Friday) is that perhaps the next step is to figure out the PSA density. I believe high PSA runs in the family and I know Dr. Scholz has mentioned at least one patient that has a high psa but seems to be without cancer.
For now I think it is a waiting game. Anschutz is a center of excellence but is two states away so I'm not able to take advantage of the mental health opportunities. I live in a rural area and have not found a good solution for me. There are a couple of local social workers but I seem stuck with them and would prefer someone that understands the dynamics of a cancer patient. I would like to run again I've regained a lot of weight and I no that's not good for my cancer battle. If you made it this fart thanks for listening to my rambling. If you have other ideas I should be looking into let me know please.
Sometimes we are marathon patients. You know the ones who finish marathons? The runner who finds their stride and pace. Don't give up. Adjust and reset your pace. In the meantime, have you considered online therapy support to supplement the local social work services?
Stay strong…
@@derickdevindavis thank you. I have gotten some online help. I hope I’m in it for more than just a marathon 🤷♂️, I get what you are saying and that has been what I have done up until my energy was sucked out of me. And I pushed on for at least another 6 months before I ran out of push. Now I’m just hanging in there hoping I will get better eventually. I just ordered a book that may be able to help me out of this long covid thing. Fingers crossed 🤞
Seven years ago my PSA was elevated and detected by my MD at annual exam. I was given antibiotics for two weeks to see if there was infection in the prostate. My PSA remained the same. The next step was a 12 straw biopsy. One straw showed cancer and another was suspect. I was given a Gleason score of 4+4. I was given a three month dose of Firmagon. Then I underwent 44 treatments of IMRT. 15 months of Lupron followed the Firmagon. My PSA dropped to 0.6 and remained there until my 6th year, when it jumped to 1.9. A PET scan was ordered and detected Lymph node metastasis on the right side. I was given three month Lupron shot and have just completed 30 IMRT treatments. I am scheduled for 15 more months of Lupron with additional 2nd generation drug Aberitarone (Zytiga).
From what I understand, PSMA PET Scans were not around 7 years ago and the scans being used at that time could not reliably detect tiny spots outside the prostate for treatment. My urologist told me the two tiny spots detected on my lymph nodes would only be picked up on a PSMA PET Scan. The good news is that these PSMA PET Scans are now out to make much more reliable treatment decisions, and further improvements continue to be made.
@@terranceolson9134 Hopefully, the PSMA scans will come down in price, as it seems to me, that many of us will be subject to these new scans on a future basis. Repeat scans may become necessary.
Dr. Scholz - How would you think about periprosthetic LN that are adjacent to the prostate but not pelvic nodes per se?
Question for you please. What is worse, Bone mets or Lymph Node mets? Thanks
Enjoyed your video today and I always feel better after watching your videos.
I just completed radiation treatment 25 out of 35 this morning. In July I had RP after my PSA was tested at 28 in March 2023. Bone scan, CT scan and MRI, prior to surgery, were all clear. Pathology following surgery showed spread to lymph nodes. I was sent to radiology and PSA was checked (now three weeks following surgery) and came back at 35. I was sent to get a PSA PET scan that now showed Mets to lymph nodes in upper abdomen. I began fermagon September 15 (two months post surgery), switched to Lupron now, and began radiation on January 16th of this year. I am to begin Zitega at the end of radiation. So far I have tolerated well all treatment. I have no symptoms, no lingering side effects from treatment, and feel pretty good.
Now my question.
I am stage IV with Mets to distant areas (upper abdomen lymph nodes). Statistics show stage IV five year survival rate is 28%. Your videos are encouraging but statistically it is discouraging. Can you do a show on this topic and explain the statistics and how they relate to patients that are pursuing treatment. I am confused and looking for some understanding as to what the future holds for me. There has to be some disconnect in this information.
Thank you.
Three years ago, my husband was diagnosed stage 4, PSA 22, Gleason 9, metastases to the abdominal lymph nodes. There were also some tiny, but suspicious lung nodules. He started with 26 rounds of radiation, and has been on Lupron/Zytiga for almost three years. His PSA dropped to
@@ga6589 thank you for your reply. I am encouraged by stories like yours and information I receive from these videos. I do hope they take this subject in a thoughtful video that further explains this issue. I’m 65 now, recently retired, and want to be able to make plans for our future with a better understanding and to what is ahead of us. I know there is no guarantees, but statistics do go into planning (financial, future life for my wife, how long we can manage current home, etc.).
All the best to you and your husband. I love hearing these positive stories.
Norman- yes the statistics are a bit scary-but they are old -I am sure we are in a better place now. My psa 11 months ago was 56 , stage 4 like you, mets in lymph nodes and one on spine,have been on adt ( Lupron and Erleada) , side effects are not too bad at all. Radiation treatment went fine- no problems. Last week had my MRI, and amazingly the mets have all gone ( Whoopie!) Psa still falling now at 2.9 - so hang on in there, it’s not all doom and gloom for stage 4 . I have done lots of exercise which I think is good (100miles per week on a bike)
My Uncle was diagnosed with Stage 4 with mets to distant areas and he lived for 7 years. But...that all happened 20 years ago so life expectancy is surely going to far exceed that now.
i am litening 20 times - patient= veterinarian ---- very useful
I’ve been on Lupron for 3 1/2 years, should I be question my doctor about different treatment , psa was 3.9 Gleason 9 ,had surgery two years later, my psa with up , had radiation 37 treatments, a year later psa with to 6.8
I had a radical prostatectomy that failed followed up by salvage radiation therapy that also failed. My PSA was at 0.37 just before a PSMA PET scan in January 2024. Unfortunately, the PET scan at that PSA level didn't reveal "any recurrent prostate cancer or metastases." But we know that with my increasing PSA, the cancer is there someplace.
I suspect the answer is "no," but can patients sense or feel the cancer that has spread to the lymph nodes? Is there tenderness? Swelling? Any other symptoms?
Any information about TACE, transarterial chemo?
I am currently having TACE on my prostate and lymph nodes in the groin and close to the prostate.
Results so far are favourable. Prostate tumours reduced (50 per cent) and stable, lymph nodes now not enlarged in groin.
Any thoughts, experience of this TACE treatment and outlook.
No other medical treatments this past seven years (since diagnosis).
Interesting this video came up tonite. Haven't watched in a while. I had one Partial lymph node positive after surgery...believe it or not, 26 were taken out. My cancer was growing on the edge of my prostate & it did enter a seminal vesicle. Gleason 4 + 3. I did later have a rising PSA. All scans for further metastasis were negative. I had 40 "broad area" (all) low dose radiation treatments. Although my experienced radiologist thought we got it all...based on later PSA (I did a LOT of other treatments, including homeopathic, which might have kept that number down) he was certain I may no longer have any cancer cells left. I didn't believe him...and a 7 month later PSA Test of .22 proved I was right. I get another test tomorrow--one month later to the day. The strategy now in large part is that we need it to grow just enough to finally show up on a PSMA PET scan. While that is a very scary thought, the hope is that it is still down there in the pelvic area...and was on the edge of the treated field...and simply missed or damaged...and we can target it specifically with higher-dose "targeted" radiation. Likely will go on hormone treatment as well. I am hopeful ! How might intraductal influence any disease ?? We need Cures for cancer !!
Keep fighting this monster pc u will win stay positive eat well sleep good u got this
Keep up the good spirit and look for these articles for comments about PET scans and the comparison of the PET scans:
"PSMA PET/CT is not very good; it's just the best that is widely available"
"Percent of patients in whom prostate cancer was detected by the PET indicator, broken down by the PSA of the patients"
@@FightingProstateCancer Your quotes regarding PSMA PET Scans not being very good are discouraging. Can you please provide your source?
It wasn't meant to be discouraging. I'm sorry if that sounded like that.
PSMA PET scans are good. And in several years they will be great, but they're not there yet. Look up the two quotes on Google - search it with the leading and trailing quotes, i.e. with: "", that way you look for a quote. You will find 1 post on HealthUnlocked and 1 blogpost on ProstateCancerNews. These two sites are filled with tons of information about prostate cancer. In the blogpost on ProstateCancerNews you will find a table with success rates of different PSMA PET scans. You may try to ask your doctor which PSMA PET scan they use - probably Ga68-PSMA.
Also PSA doubling time (=PSADT) may be a factor for sensitivity of a PSMA PET scan. The higher the PSADT, the higher the sensitivity of PSMA PET scan. Look for "PSMA scan with PSA < 0.20?" on HealthUnlocked. There should be 1 post with such name from user called "ron_butcher". In the discussion of the post there are two replies by user "Justfor_" with photos. They compare the probability of success of PSMA PET scan with different PSA and PSADT.
Keep up the good spirit, though. Don't let anyone on the internet to discourage you. I hope you will cure it. @terranceolson9134
It wasn't meant to be discouraging. I'm sorry if that sounded like that.
PSMA PET scans are good. And in several years they will be great, but they're not there yet. Look up the two quotes on Google - search it with the leading and trailing quotes, i.e. with: "", that way you look for a quote. You will find 1 post on Health Unlocked and 1 blogpost on Prostate Cancer News. These two sites are filled with tons of information about prostate cancer. In the blogpost on Prostate Cancer News you will find a table with success rates of different PSMA PET scans. You may try to ask your doctor which PSMA PET scan they use - probably Ga68-PSMA. @@terranceolson9134
What is proton radiation is it different than IMRT radiation
Is it possible for prostate to spread to the rib but mist the limp nose
IMRT is mentioned but not SBRT. Is SBRT an option?
SBRT is the same as Cyberknife technology...I just had three treatments of SBRT for very small cancer in two lymph nodes. Amazing tech, painless, and really is the way to go, when dealing with tiny tumors! Insurance now covers most, but not all, of the treatment charges. My three treatments will cost me $600 out of pocket...not bad at all, considering that the actual total bill for those three treatments was $2,700 ! These new treatments should not cost so much!..But what can we do?...It is life-saving technology. My PSMA scan-that spotted the lymph node situation, will cost me over $3,000 copay! Hopefully, these prices will come down.
Is enlarged lymph nodes close to a newly diagnosed PC always metastases, or can they be enlarged just due to them fighting the inflammation caused by the PC and simply doing their job?
I had a prostatectomy followed by radiation to reduce the psa with 2 years of lupron. Now my Testosterone is up to 258 and my psa went from a hormone controlled .2 to today’s number of 1.8 and in 2 weeks I’m going to get my PSAT to set the future plan. Yes, that puts me 5 years out from surgery that had a clear margin removal.
how about surgery with two nearby lumph nodes?
I queried surgeon who does robotic surgery and he said they don't take first lymph in men in Australia anyway (they do in women when doing hysterecomy/oophrectomy)
Dear Dr. Please my husband has prostate cancer and very severe. He is very anemic and we keep getting blood transfusion. Please what can we do.
Hello, we are sorry your husband is going through this. We have a Helpline who may be able to help and give you information. You can reach out to them here: pcri.org/helpline