Imaging to detect lymph node involvement?

I am trying to figure out whether imaging tests such as MRI, color Doppler ultrasound, bone and CAT scan can help determine whether or not prostate cancer has spread to the lymph nodes. I recently had a doctor tell me that imaging is worthless for determining this, but I recall hearing otherwise somewhere else. Same doctor also said that he believes that the risk for lymph node involvement is significantly higher than what is shown in Partin tables.

Tall Allen,

Thanks for the reply. So whole pelvis treatment would involve external radiation in addition to the HDR brachy treatment, correct?

I'm trying to figure this out, because I believe I am currently scheduled for HDR mono-brachy, but a different R.O. recently told me he would only give me brachytherapy (either LDR or HDR) in combination with external radiation due to the risk of lymph node involvement.

I thought that my color Doppler ultrascan results had pretty much ruled out lymph node involvement, but maybe I didn't understand this correctly.

Also, I just found 2 studies which claims that HDR monotherapy would be appropriate for someone with my PSA, GS, etc:
www.redjournal.org/article/S0360-3016(06)01897-9/fulltext
www.sciencedirect.com/science/article/pii/S0022534711049950

You are correct that whole pelvis treatment would involve external beam radiation to all pelvic nodes in addition to the HDR brachy boost to the prostate.

It's going to be a judgment call on your part, as you carefully weigh the risks against the benefits. On the plus side, your highest GS was 3+4. On the minus side, you had several suspicious lesions identified on CDUS, which would stage you at T2c, if they were on both sides. You also had a high volume of cancer in the highest grade cores, a several cores with cancer. According to the latest NCCN definitions, men with 2 or more intermediate risk factors may be treated as high risk.

As far as I know, CDUS cannot detect cancer in the LNs. In fact, I don't think they even look at it.

In the Demanes study you cited, of the 114 men in his sample, only 16 (14%) were PSA 10-15 and only 9 (8%) were GS7. So the number who were GS7 and PSA 10-15 was less than 9. It's hard to draw conclusions from a sample that small. Also notice that 26 men were also treated with ADT - I'd bet that included all of the men in that group.

In the Rogers et al study, they write "We recommend caution for percent positive biopsy cores exceeding 75% or clinical stage T2c."

I'm not saying monotherapy is a bad idea. In fact, considering the low side effect profile, it may be a great idea. There's also the possibility of zapping the pelvic LNs later only if there's a recurrence, but that has risks as well.

- Allen

Tall Allen said...
You are correct that whole pelvis treatment would involve external beam radiation to all pelvic nodes in addition to the HDR brachy boost to the prostate.

Allen,

I'm wondering why HDR brachy is used in conjunction with EBR. Why couldn't SBRT be used instead as a mono therapy since it both emulates HDR brachy and is itself an external beam radiation?

ARangel14,

It sounds like your hubby has had no type of imaging, and your former urologist is basing his treatment recommendations solely on the biopsy results and PSA numbers. I think there are many doctors out there who believe that imaging such as mpMRI and CD Ultrasound give valuable information about the location and size of the tumor that cannot be ascertained from the blind biopsy samples.

I have found, right from the beginning, that it's a good idea to consult with a Medical Oncologist, just to keep the Urologists honest...They have insights about treating cancer you won't get from a urologist..

Fairwind,

I agree 100%. I was lucky to have found an oncologist who specializes in PCa to do my biopsy and give me the initial diagnosis.