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Should radiation be carried out after orchiectomy when (multiple) lymph node(s) are involved?

jeetu
Posts: 4
Joined: Sep 2013

Hi everyone

I've joined this network in the hope that someone here can help my father who has been diagnosed with prostate cancer with the following history:

Age: 68
PSA post TURP - November 2012 - 17.6

Biopsy of TURP specimen confirms prostate cancer

Initial Glaesons score given as 5 (2+3) - this was later deemed to be incorrect

Bone scan - negative

Based on this misleading Glaeson's score we opt for watchful waiting.

PSA - July 2013 - 23.3
Orchiectomy performed on 29/7/2013 along with a fresh Biopsy.

New Glaesons: 8 (4+4)

Bone scan - negative

MRI now shows cancer spread out of the prostate, seminical vessels and one lymph node shows up as enlarged. (text of the conclusion of the MRI pasted below)

Stage:T4N1M0 - One enlarged lymph node seen but there maybe other smaller lymph nodes that are also affected.
PSA - September 2013 (post orchiectomy) - 0.166
MRI - September 2013 - There is a reduction in size of the prostatic mass and the right external iliac lymph node (measuring 1.4 x 0.4 cm)

Currently we are trying to decide whether we should go ahead with radiation post this orchiectomy. The doctor performing the orchiectomy had recommended we follow up with radiation.

Another doctor seems to think the progress has been good. His initial thoughts were that whether radiation will be beneficial from this point or not is still a matter of study and due to lymph nodes being involved a larger area would have to be radiated and therefore chances of side effects are higher.  Also since most likely multiple lymph nodes are involved the chance of radiation being of any help is lower therefore he does not recommend it.

I would sincerely appreciate if someone here could shed light as to whether doing radiation in this scenario is beneficial or if the side effects are so damaging that it is best we avoid radiation.

Sincerely appreciate any help since quite honestly we're very lost at the moment.

Regards,

jeetu

 

Therefore we are currently at crossroads trying to deliberate which of these doctors we should follow i.e. to do radiation or not.

I would sincerely appreciate an opinion on whether considering all of the above we should continue on with radiation or not.

Regards,

Jeetu

------------Excerpt of the MRI conclusion as on 26072013---------

Known case of carcinoma of the prostate, post TURP status. The present MR examination shows a large mass lesion involving the central and peripheral zone of the prostate on either lateral sides (left more than right) with an exophytic component on the left posterolateral aspect which is involving the seminal vesicles (left larger than right), with suspicious involvement of base of the bladder wall and an enlarged right external iliac lymph node.

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------------Excerpt of the MRI conclusion as on 16092013---------

Overall in comparision to the previous MRI there is a reduction in size of the prostatic mass and the right external iliac lymph node

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lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

jeetu I am glad to welcome you to our forum but also sorry to hear about your father. First let me say I am not a medical professional. Just another prostate cancer survivor.

I'm age 59 with Gleason 7. Davinci surgery 4 years ago. Currently undergoing 38 treatments of IMRT Radiation since a positive margin I had post surgery started to increase my PSA.

Your father definetly has a hard case as you know. I've been told they are radiating an area in my prostate bed about 2cm in size. So far (Today is treatment # 15) my side effects have only been fatigue from the treatments and some soreness in the Groin area.

Have you talked specifically to radiation doctor that specialized in Prostate Cander?

Do you live near a major city where they have a prostate cancer specialist?

With two differening opinions as you have been given I think I would look for a specialist and not just a local Doctor.

Someone obviously messed up big time giving your father the gleason 5.

I'm sorry to give you more questions than answers but just my thoughts. I'm sure some one else will be responding to your post perhaps with more knowledge than I do in advances cases such as your father. Please do keep us informed.

 

lewvino

 

jeetu
Posts: 4
Joined: Sep 2013

Hi Lewvino,

 

Thank you so much for your response. I appreciate hearing from someone who is going through a similar experience as my father.

 

>Have you talked specifically to radiation doctor that specialized in Prostate Cander?

 

Yes we've been speaking to doctors who are uro-oncologists. We have also consulted a radiation therapist (oncoradiologist is the term I think).. In addition we have also been speaking with doctors in the US through relatives that stay there.

 

>Do you live near a major city where they have a prostate cancer specialist?

 

We stay in Bombay, India so we do have good access to specialists here, hospitals and even the latest in radiation machines etc.

 

>With two differening opinions as you have been given I think I would look for a specialist and not just a local Doctor.

 

We have been speaking with specialists however both have given differing opinions as yet. I'm currenlt waiting to hear from the doctor in the US, his initial take has been that radiation would help little after he realized that though there is one major lymph node that shows up in the MRI there are smaller lymph nodes that have also shrunk after the orchiectomy suggesting they were positive for cancer too. He is going to discuss things with radiation oncologist colleagues before getting back.

 

My father seems relieved he doesn't have to go through radiation. His take is that he wants quality of life more than length of life.

 

It would be great to have clarity on whether radiation will help significantly and if we should go for it or the side effects when multiple lymph nodes are affected may not warrant it.

 

Thanks again for speaking with me. I sincerely hope and pray that you heal and feel better soon.

 

Regards,

jeetu

 

 

 

 

 

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

I'm glad to hear that you have covered the basis with talking to the correct people. Yes there are always differences in opinion so that again makes decisions harder.

I'm curious if they could do surgery to at least remove the lymnp nodes that are enlarged infected? Not sure if that would help or not since once in the lymph nodes then I believe the cancer can spread easier.

Luckily my lymph nodes were clean and only had the positive margin in what they call the prostate bed so that is where they are aiming the radiation at now.

 

Best wishes,

Lewvino (larry)

 

jeetu
Posts: 4
Joined: Sep 2013

>I'm curious if they could do surgery to at least remove the lymnp nodes that are enlarged infected? Not sure if that would help or not since once >in the lymph nodes then I believe the cancer can spread easier.

 

I discussed this possibility with one of the doctors however he said that once it is in the lymph it would have microscopically travelled to the other lymph nodes too and therefore it did not make any sense in removing the lymph node.

 

I hope things work out well with you and you recover really soon. Thanks for writing.

 

Regards,

jeetu

Samsungtech1
Posts: 350
Joined: Jan 2011

Jeetu,

I had about the same diagnosis as your father.  My lymph nodes were clean, but had metastis to lungs.

I chose to have prostate and seminal vessels, nerves etc removed.  It had spread to bladder neck as well.  They sent me for radiation, 38 treatments. This was June of 2010.  I had radiation on lungs in 2011.  

IMHO , I would think if it  has spread ro vladder neck they should have radiated it.  I am confused about his course of treatment. I am not qualified to give advice, but the cancer was left.  Why?    

Mike                            d

jeetu
Posts: 4
Joined: Sep 2013

Hi Mike,

 

Thanks for sharing your condition. I do hope all goes well for you.

 

None of the doctors we've spoken with seem to be worried about the bladder at all based on the MRI.The first MRI says suspicious involvement however even after the second MRI the doctors don't seem to be seeing anything at the bladder.

 

We've spoken with a few doctors here including a radiation oncologist, we've also shown the MRI images to doctors in the US, therefore I think currently the bladder isn't something that has anyone worried.

 

I shall still try and question the doctors on this the next time I speak with them.

 

Thanks so much and pray all goes well with you.

Regards,

jeetu

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