Stage IV?

Keith,

I know this gets confusing. You are not pathological stage T4 unless the cancer was detected on nearby organs outside of the prostate. Any pelvic LN involvement is called stage N1.(If distant metastases were detected, it would be stage M1 as well.) Now this is where it gets confusing: anyone diagnosed with N1 is put into a category called AJCC Prognostic Group IV (note the roman numeral). But the nomenclature is not very important, what is important is what you can do about it.

Sloan may want to give you a more accurate body scan called a PET scan. They are testing some very good ones there. This will help rule out any distant spread. If your cancer seems to still be localized to the pelvic area, there are two potentially curative approaches:

(1) Extended pelvic lymph node dissection (ePLND): They sometimes use a fluorescent dye to help the surgeon find and remove as many lymph nodes as he can (usually about 20), or,

(2) Whole pelvic external beam radiation: they will zap the entire pelvic LN area to kill any remaining cancer that may be floating around in the lymph there.

ePLND carries a risk of lymphocele and lymphedema. The salvage radiation may make urinary symptoms, ED, and bowel symptoms worse.

I'm sorry you find yourself in this situation, especially at your age. But it's a good thing they found it, and Sloan has some great doctors with the experience to deal with this.

- Allen

Welcome to HW, sorry you need to be here.

Sounds like you're in great hands with Sloan. I know it all seems a bit scary and weird, but you've got a great team behind you and every reason to hope for a good outcome.

If you have any questions, let us know. Lots of good folks around here to help with your questions.

Hang in there,
Andrew

Dear Keith Ryan,

Just wanted to extend a handshake of brotherhood towards you, after reading your post.

We've got several members here, just like you, who have been diagnosed in their 40s --- and I was also diagnosed when I was still in my 40s, as well. Just wanted you to know that you've got friends and comrades standing right alongside you now RIGHT HERE --- and we're here to encourage you and support you, in whatever way you need.

This is a tremendous place to visit --- here, you can seek advise, wisdom, counsel, and even solace. We've got members hailing here from every "neck of the woods" located across this great country of ours, and very valued members from across the globe, as well --- in just the past few days, we've had messages here from Scotland, Norway, India, England, & Switzerland. This website is truly reaching out to a GLOBAL audience ... and the power of that is that we are able to "share and compare" our collective experiences with each other ... past, present, and ongoing.

More than anything else, when you post here, you will discover a fraternity of BROTHERHOOD among our members ... and you've just discovered a very CARING CORNER of the world by visiting here ... we've got members checking in 'round the clock, weekends and holidays ... from all over the globe. It's a tremendous resource ... stop by OFTEN and check in here with the fellows ... no social or membership dues in this fraternity, my friend !

We invite you to continue sharing your experiences with us over time --- let us know how you are faring and how things are going for you.

Handshake from across the miles, Keith Ryan ~ from a fellow "Brother In The Battle" alongside you,

"Cyclone Team Fan" ~ Iowa State University

Depression is a common side effect. Most times it just goes away in time, but some us needed a little help to get over that. Walking, and doing things to lift your spirit can help a lot. Talking about the problem helps and more than a few of us need a little medical help to get over the depression. It's common, complain to your doctor about it if it doesn't get better.

Hang in there, it does get better with time. Someday this will all just be a bad memory.

Andrew

Will do Bololidat! If the results aren't posted to the portal today I will call them tomorrow. I am almost positive they only took out 2 nodes but will find out for sure.

In the US, most places typically just take out a few LNs (PLND), because of toxicity concerns. Only a few places routinely do ePLND in high risk cases. ePLND is difficult without special detection equipment. That's more a European thing. Mayo is doing a lot of it too.

My surgeon managed to excise 44 nodes and one of those little guys had a 1mm carcinoma. At that point it was Lupron and salvage radiation in the future for me.

Gemlin-
One of the big differences between Europe and the US has been that cases are less advanced in the US and less likely to show LN involvement. So the thinking here has been that it's not worth the risk during a routine RP. Also, it takes practice and skill. Lymph vessels and nodes are networked and in slightly different places in everyone. They're clear and practically invisible against the blood vessels and flesh. They can't just cut away to hunt for them because that can do a lot of damage. The fluorescent dye technique just became available a few years ago and is not available everywhere. And the more lymph nodes removed, the higher the risk of lymphocele and lymphedema. Often, the doctor will look for some evidence of an enlarged node before cutting away. NCCN has been endorsing ePLND, so it is changing in the US for high risk cases. The open question is whether it's better to do salvage pelvic LN radiation after PLND detection, which can treat even the small nodes they can't find, or to do the ePLND surgically during RP. There are no clear answers.

- Allen

Hello Keith Ryan,

Sounds like you're experiencing some of the anxieties, worries, and possibly fears that go along with a diagnosis. It's all part of the game at first --- restlessness, worrisome thoughts, and sleepless nights --- we've all experienced some of that, in some way, shape, or form.

It's a lot to deal with at first --- then, the dust begins to settle --- you fall into new routines --- and courage and acceptance come around the corner.

Don't be afraid to reach out here --- you've got a "Band of Brothers" right here, anytime you need --- we're here to listen and to support you as a fellow comrade --- we've got a fraternity of brothers here --- loyalty and friendship. Don't hesitate to reach out ...

Looking back over my shoulder a bit --- some advice that helped me --- stick to your usual daily routines --- don't let cancer take over your daily living. In other words --- stay connected to your family, friends, and faith, in whatever form that takes for you. Keep pursuing those hobbies and interests of yours --- don't lose sight of the things you enjoy most. Stay connected with the world --- the people around you --- and keeping busy does WONDERS for keeping the "wolves of worry" at bay on those dark days that can come creeping around the corner sometimes. Set a couple of new goals --- go on a weekend road trip --- get together with the fellows --- go golfing --- work in the yard --- go fishing --- set up a poker club night --- work a community volunteer project --- quite simply, keep living life each day !

Along the way --- build a support system, in whatever form that takes for you --- make sure you are closely connected to a brother, a work colleague, an old high school classmate, a clergy member, your old college roommate, someone from church, a trusted neighbor, your golfing or fishing buddy --- a person in your life that you can truly CONFIDE in and stay connected with. I've got direct friends of mine who now share in my diagnosis --- we're all about the same age --- we now have a bond of brotherhood because of our health diagnosis, but more importantly --- they are my trusted FRIENDS. Seek out those people in your life who will be there for you, no matter what --- they become part of your TEAM. Call them up if you have to --- get together --- lay your cards on the table --- open up to them --- confide in them --- form that bond --- we all need friends in this.

In my estimation, there's also no substitute for staying active and keep pursuing your social life --- a sure way to lift the clouds of despair. As well --- and everyone here will attest to this --- a bit of exercise in your life each day can go a LONG WAY towards wellness --- physically and emotionally. A stroll around the neighborhood --- walking the dog in the park --- some yard work --- or a stop at the local gym --- whatever form of fitness appeals to you most. My favorite --- a late night walk --- it gives me a chance to reflect on the day and to reflect on the value of each day. Do what works for you ...

If the blues persist over time, fellows in our shoes need to feel comfortable discussing that frankly and honestly with their doctor. Doctors will listen, and will provide solutions. My doctor and I have a strong bond and he has always said that if I ever struggle with the blues, he is there to help me with that, and that there should never be any hesitance to ask for help. It's hard for fellows to do that sometimes, though ...

Just wanted you to know that the fellows are here for you --- another motto of mine that I think might be helpful to you, since we both have been diagnosed when we were in our 40s --- I set goals for each day --- I stay active --- I reach out to others, and others reach out to me --- I work hard to keep my head in the game --- I have stayed true to all my family and friends --- I also draw strength from my faith --- staying involved in my usual hobbies and activities really helps, too --- and staying active socially each day.

One more thought to leave you with --- a cancer diagnosis is now one CHAPTER in your life's story, as we all admit to ourselves --- but none of us should let a cancer diagnosis become the TITLE of our BOOK OF LIFE. I've come to that realization over time, and thought maybe that philosophy would encourage you right now as you begin looking ahead, setting new goals, and facing forward.

Stay in touch --- glad that you are posting --- staying in touch right here is great way to stay connected !

Quotable quote for today from baseball legend Jackie Robinson, "LIFE is NOT a spectator sport." Some words for all of us to aspire to ...

Sent with my best to you, from a fellow "Brother In The Battle" ~
Cyclone Fan ~ Iowa State University

hi Bololidat

I received the pathology report. I think 26(??) nodes were removed

1. Right pelvic lymph node - number of nodes examined: 9
2. Left pelvic lymph node -

• metastic prostatic adenocarcinoma
  
• number of lymp nodes examined: 17
  
• number of lymph nodes with metastatic disease: 2
  
• size of largest lymph node involved by tumor: 1.1cm
  
• size of largest metastatic focus: 0.2cm
  
• extranodal extension is identified
  

There is another section which talks about that. It says 'Free of tumor'

Tumor location: right prosterior, right anterior, left posterior, left anterior
Dominant tumor mass located in left prosterior apex - base, with extension into right posterior

Vascular Invasion: identified

Perineural Invasion: identified

Tumor Multicentricity: Multicentric foci of invasive carcinnoma are present

High Grade Prostate Intaepithelial Neoplasis: Identified

Capsule: Established extracapsular extension. The location of extracapsular extension is left posterior apex to base, right posterior base

Seminal Vesicles: Not involved

Bladder Neck: Not involved

Surgical Margins: Free of tumor

Non-Neoplastic Prostate: Exhibits chronic prostatitis

Staging (AJCC 1997) pT3a (extracapsular extension)

Keith…I scares me self..

Ok,given that,there is a possible chance of lymphocels developing…not a given…JohnTX had a godawful bunch taken and do not beleive he ever got them…refer to post up the page a bit of my description of my experience. TA mentioned possibility of Lymphedema as a reason why some doc to not do node dissection un less hi risk .. I would not be concerned with that..It is rare in the pelvic area… much more common for breast cancer patients.. and much more serious than lyphoceles.. I concur with fair wind…for some reason…Patrick Walsh gets a bad rap on this forum…Read and study up on the chapters that are revenant to you…they are self revealing… Lots a guys would be totally impotent without Walsh.. He discovered that erectile nerve bundles lay outside and over the Prostate and could be saved… prior to that it was thought they were completely inside the prostate and out they want with the prostate.. sleeping quietly and happy overlying..ask ing to be saved… Not a stupid man and with a name like Patrick can't be all bad..right...Keith Ryan… young fella ya be...