Treating Lymph Node Metastases
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- เผยแพร่เมื่อ 3 พ.ค. 2023
- In some types of cancers, the word "metastatic" is associated with other words like "incurable" or "life-threatening." In the context of prostate cancer, however, metastatic disease is almost always more vulnerable to treatment than other types of metastatic cancer.
This is especially true if the metastatic prostate cancer is limited to the pelvic lymph nodes. In fact, for patients with spread confined to the pelvic lymph nodes, there may still be a chance to achieve a cure or a long-term remission, and new technologies are likely to improve these patients' odds even further in the coming years.
In this video, medical oncologist Mark Scholz, MD, discusses how the PSMA PET scan and advancements in treatment delivery are providing physicians with more accurate disease staging and thus more specific treatment selection, which is offering hope that men with these kinds of high-risk and relapse cases will have even better outcomes in the coming years.
0:07 What is the minimum Gleason score for which there is a possibility of lymph node metastasis?
2:09 How do prostate cancer metastases in the pelvic lymph nodes differ from how people usually think of "metastasis" in the context of "cancer," in general?
3:36 What is the limit for the number of metastatic lesions that can be treated with spot radiation?
4:34 If a patient has lymph node metastases, is it a foregone conclusion that they will need hormone therapy?
6:08 Which form of radiation delivery is best suited for "spot radiation" to metastatic lesions?
6:41 What are the side effects of irradiating a person's pelvic lymph nodes with the intention of long-term disease control?
7:51 There are two common categories of men in this situation. One -- men who are newly diagnosed with prostate cancer with metastases in the lymph nodes, and two -- men who have been treated for prostate cancer, and have since relapsed, but without any known or suspected spread beyond the pelvic lymph nodes. What are the similarities and differences between these two categories?
9:34 What advice do you have for patients with lymph node spread for coping with being presented with a litany of options while at the same time facing a potentially dangerous diagnosis?
Don’t know your stage? Take the quiz: Visit www.prostatecancerstaging.org
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The Prostate Cancer Research Institute (PCRI) is a 501(c)(3) not-for-profit organization that is dedicated to helping you research your treatment options. We understand that you have many questions, and we can help you find the answers that are specific to your case. All of our resources are designed by a multidisciplinary team of advocates and expert physicians, for patients. We believe that by educating yourself about the disease, you will have more productive interactions with your medical professionals and receive better individualized care. Feel free to explore our website at pcri.org or contact our free helpline with any questions that you have at pcri.org/helpline. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.
The information on the Prostate Cancer Research Institute's TH-cam channel is provided with the understanding that the Institute is not engaged in rendering medical advice or recommendation. The information provided in these videos should not replace consultations with qualified health care professionals to meet your individual medical needs.
#ProstateCancer #MarkScholzMD #PCRI
I just cannot thank both of you so much for the excellent information. This information has been so helpful while navigating my advanced prostate cancer. Keep up the excellent work!!!
Alex, Again... THE BEST Questions Asked and the Best Dr. answering them. Well Done. Thank You! You are helping millions of men.
Thanks! You folks are very much appreciated!
Love these conversations/discussions by Alex and Dr. Scholz. Thank you so much for understandable language.
Thank you
Robotic Surgeons at UCLA are now using PSMA expression in real time to target and extract cancerous lymph nodes and to check in real-time that no cancer is left behind. “PSMA Radioguided Surgery”. Very clever.
Once PSMA PET emerged (UCLA was a very early site) the challenge has been to harness some aspects of it to destroy the prostate cancer it is so good at locating. (lutetium-177 PSMA therapy is another effort in this direction).
I just watched the UCLA video on radio guided surgery. Looks promising, but not sure if it's been adopted anywhere else ? Also, the UCLA video I watched stated that the 'benefit remains unknown'.
i learn a lot as usual tks
I happened upon this particular video dealing with lymph node involvement at precisely the right time. Thank you so very much for the education, the information, and the guidance.
Thank you ✌
You're welcome 😊
What about a singular non enlarged lower abdominal lymph node metastasis?
Thanks for an excellent discussion about lymph nodes.
EXCELLENT many thanks Dr. Scholz and Alex
Fantastic, just diagnosed with lymph node metassis very helpful
How are you doing now ?
Excellent info.
What’s your take on the mitochondrial link to cells turning cancerous?
This channel is gold. I just got result of PSMA Pet scan, (done with the advice from PCRI ;-)) and it said all is contained in the prostate exept one little lymph node right next to the prostate. With a PSA at 124 when I first got tested, I feared much worse. :-) But, here is a kicker (a topic that saw me thrown out of a prostate cancer support group on Facebook with 30K members :-( ) I have had 5 PSA tests. First in August was 124. Got on antibiotic because of prostatitis for a full month. PSA down to 97. Following month I did not much but research. No change to my life. PSA climbed to 120. Then I decided to see if I could do something about it myself. After a month PSA 93. And I just had the last PSA after another 1.5 month and my PSA is 78.71. I want this out, but I do not want to try other options first. So, what would be a smart thing to do? One single lymph node got cancer right next to the prostate, but my PSA is trending down without treatment. My Gleason score was 5+4 by the way, and only 3 cores taken. It was too painful. ;-)
PSA can fluctuate but 78 is way too high. You won't heal it all by yourself. You should do something with it before it gets worse.
I follow the PSA very closely, and I am prepared to accept that I might need both ADT and Radiation, but I am measuring my progress by the same means urologists do, so as long as I can keep it from going about the initial number, and as long as I think I got alternatives, then I will continue my efforts to bring this to an end on my own. Once on medication, I can no longer verify progress using PSA, and right now I am a healthy 54 year old, with ZERO sympthoms and issues, but the same second I take the jab, I am a sick man with compromised immunesystem. And this to do what I am doing now, without being compromised. @@FightingProstateCancer
PSA is only 1 of the markers. You are lucky that with your extremely high PSA the cancer is contained to prostate and to 1 lymph node. But it's already in the lymph node, so it's not that great. Gleason 5+4 is extremely aggressive as you can see - it means that the cells can live outside the prostate. You say that you have "only 3 cores taken", yet your lymph node is already hit.
You are lucky that you had a PSMA PET Scan. This scan is quite new, expensive and even in developed world not so easily accessable.
You are not healthy, you have cancer. You should hit it with intention to cure and continue with normal life.
Don't you have a family, friends or someone who may be worried about you?
You are not symptomatic - prostate cancer is symptomatic only in the last stage. Lucky for you, prostate cancer is one of the slowest cancers. Yet it slowly gets there.
If you don't like the pain, then you should cure it now.
Try the Staginq quiz on: pcri.org/staging-quiz
And read The Prostate Cancer Staging Guide on: static1.squarespace.com/static/54c68ac6e4b06d2e36a4b8c9/t/5b27f0fc575d1f7e236b578f/1529344254467/The+Prostate+Cancer+Staging+Guide+web.pdf
Or buy the book "The Key to Prostate Cancer" by Mark Scholz, MD from year 2018.
The Prostate Cancer Staging Guide on the web is almost the same as the book "The Key to Prostate Cancer"
I think you would fall into stage named "High-Azure".
You're lucky that it was found.
Hope that helps. @@LarsSchaferVP
@@LarsSchaferVP I wish you the best of luck, and I will pray for you.
Thank you. Alot questions answered. My husband has aggressive stage 4a prostrate cancer in the lymph nodes. His cancer is also in the whole prostrate. I'm worried. Surgery is not an option. He will be having hormone therapy and radiation. Sees cancer doctor on Tuesday. I pray this will take care of it. 😢🙏🙏
Sharon’s ithip2kr. How is your husband doing, my husband was just diagnosed with same exact diagnosis as yours, he received his first hormone shot last week
Age 71. Prostrate Cancer Stage 4, Gleason 9; 2 Tumors, one in lymph node near Prostate and one in Prostrate per PET Scan. This video matches my Medical Team's opinion exactly. On 2 Hormone Pills and Radiation treatment. My goal right now is to get my PSA score down from 10 to something normal. Then we'll go from there. This is a great video for me. Thanks.
Are you okay?
Like to know how its going..I have the same thing
Hello
Psa went down to 1.7 after sabre treatment then to 1.5 but last test up to 1.6
Am having IMRT for local lymph node involvement. The only real side effect I’m having is diarrhea. Doctor suggested diet changes and Imodium.
I’m struggling with the “one and done” approach vs trying to minimize radiation side effects. I have unfavorable intermediate and my radiation oncologist says my risk of lymph node involvement is somewhere between 10 and 15%. Says I could go either way when it comes to radiating the lymph nodes or not as part of my initial treatment.
I had psa of 1,300. Came down to .11 within 2 months. Does that mean, no more cancer or cancer stopped growing?
I’m taking Lupron shot every 3 months, taking Xtandi 160 mg, biclutamide. I’m also getting shot of xtigo every month. However I fractured my knee. What caused it?
Can you get a PSA bump after SBRT to lymph nodes? Thank you
Dr Scholz,
I have gained tremendous insight into prostate cancer by doing research wherever your videos have led me. Would you give hints as to where to go for support groups?
I have failed all treatments including Pluvicto and docetaxel.
Would you explain late stage prostate cancer?
Hello Tom,
Thank you for your kind words.
One of our team members, John Shearron, is an advanced prostate cancer support group leader and would be a great resource: pcri.org/john-shearron | Please feel free to reach out to him via this link: pcri.org/helpline
Here are some support groups and advocacy groups:
ancan.org/prostate-cancer/
www.cancerabcs.org/contact-us
zerocancer.org/get-support/peer-support/find-a-support-group/
What if prostate cancer has spread beyond the pelvic lymph nodes? What if it has spread to lymph nodes near stomach region? What are the percentages of curing it then?
Are there lymph nodes that are not treatable with radiation because of their location ?
Thank you for this information I’m in the beginning stages of anal cancer and found out I have lymph nodes metastatic need more information just starting radiation will have biopsy
When they told me I had prostate cancer it had already spread to most of my lymth nodes. My PSA was 5000. They started hormon therapy and nobody told me how bad that can be. Sweats that last for hours or even all day. Wake at night with pillow and beding soaked from sweat. Hair soaked and running down my head and damaged hearing aides. he is totally wrong as hormon therapy has terrible side affects. Now I have had problems with passing out and falling.
Medical doctors almost killed my gramps
Try fasting with a keto diet my friend. By doing this it starves the cancer from glucose and glutamine, there energy source.The good cells live off the fatty ketones. They don't talk about this because it's not profitable! There are thousands of studies that are shown to be 85 to 90 % effective. Look into it GL
My doctor never told me I would get enlarged breast and now on these video I hear that could have been prevented at the start. I cannot even get an appointment and just go to get treatment every three months. Only can speak to his nurse. Is that how everyone is treated. Binder in Albuquerque.
Ask your doctor for meds to control the hot flushes. Mine weren’t as bad as yours but I got the meds anyway.
@@guyonabike2415My doctor does very little communication with me. Like my cancer is so bad not worth dealing with me. At least my palliative nurse does more. Helps maintain pain meds as pain increases. Has tried multiple drugs to slow the terrible sweats.
I have a bad heart and a pacemaker. I thought my heart doctor and oncologist would communicate more as one affects the other but nope.
My PSA was 7.7 Gleeson 6.. I underwent 5 SBRT sessions and 6 weeks after last session my PSA was 4.4 . 6 months later PSA has jumped back to 6.5. Is this just PSA bounce or something recurrent ? I have PSMA -PET scan scheduled in a 2 weeks
🥰
After chemo and radiation my psa 0.010 for four years and five months.threeonths ago the testerone level eas 56 last week the number is 105.the psma pet is negative.what is the number for testosterone to be
What about lymph node sugery removeable
We have been told that because my husband had radiation therapy 17 years ago after having his prostrate out!!
he can’t have it again to treat cancer now found in the prostrate bed they have said it might do damage to surrounding area
If you’ve been through treatment such as chemo, and your PSA is undetectable at this point, is it useful to get a PSMA-PET? It’s been two years. Would you expect to see any new Mets? Please answer.
I say only time will tell how it's going to go may God be with you I am in the same boat waiting to see what happens really sucks
I know this because I am in the Mayo series. Mayo Clinic has a developing case series of PSA negative people with positive PSMA PET/CT. A similar case series is also being collected in Australia.
@@stevenpeterson659 I’m not sure what you mean, can you explain?
@@Mary-bx8gd There are clearly a group of patients who predominantly have been diagnosed with high Gleason Scores who have been treated and now have PSA levels below the level of detection by the test. However, if you do a PSMA PET/CT you will find PSMA positive lesions that are recurrent or persistent foci of prostate cancer. Insurance has set a requirement of a PSA of 2 for a PSMA PET/CT, this requirement is probably not valid in all patients.
Would Pet Scan give any more data?
Hello,
Our helpline may be able to give you more information about PSMA PET scans. You can find their contact information at pcri.org/helpline.
if psa is less than 0.04. is it useful to have PSMA scan or wait till PSA reaches 0.2 or more
Good question, I hope you get an answer, my husband is in the same situation.
I am from Australia and I recently completed 25 sessions of targeted radiation on cancerous lymph nodes in my clavicle and abdomen/pelvic region. 6 weeks following radiation my PSA dropped to 0.03 ug/L (using Roche Cobas method) which my Radiologist (Prof Shankar) classed as undetectable. According to the Professor, if my PSA rises to 0.2 ug/L then a PSMA PET scan will only be 30% accurate whereas if the PSA rises to 0.5 Ug/l then the PSMA PET will be 50% accurate. Generally speaking, the higher the PSA level, the more likely a PSMA PET Scan can detect and identify recurrent prostate cancer. Whilst the PSMA PET is fantastic it has a limited resolution of 2-3 mm. Anything smaller, particularly microscopic cancer cells, will not be detected. That is why the PSA has to rise to a certain level before it "may" be visible on a PSMA PET scan. It will up to your oncologist to decide when best to carry out a PSMA PET scan.
You should ask your doctor can I be watch in your case he may want to do the psma talk to him let them know what you want
I know this because I am in the Mayo series. Mayo Clinic has a developing case series of PSA negative people with positive PSMA PET/CT. A similar case series is also being collected in Australia.
After chemo and radiation what is the number of the testosterone
As usual, I am even more confused.
I already had 20 doses of radiation. Afterwards my PSA was 1.9 and has climbed to 5. in 18 months. I now have spots in "quote" 4 to 5 L Nodes. they now put me on 18 months of depot hormone treatment. My first injection two weeks ago. I do not want to continue with the next 5 by 3 monthly injections.
I am looking at keto and carnivore diet. I can not see the point of years of toxic unnatural stuff in my body with all the side effects to come.
How long could I live before I am gone and I wonder how many of those years would be as comfortable as i am this stage of my life. I am 71.
Sad noone even tried to answer you
Hello, what is your Gleason score? You can live years on hormon terapy if response is good.
I watch your videos which are helpful. That said, there is one aspect that is not clear to me. I was a Gleason score 9, had surgical removal of the prostate. Approx. one year after surgery PSA began to rise and then treated with ADT and radiation. PSMA pet scan was not yet available. Currently I am in remission based upon my PSA. From a statistical perspective, having been a Gleason score 9 am I at a greater risk of future disease recurrence?
You know I would like to know that myself mines is a very aggressive type cancer 4+3 also 4+5
I otp to have it removed it bout to be a year a month I know it kills me to have to go through life wondering if and when it's going to come back
@@blackknight125 we’re you stage 4 Gleason 9 and went into recommission. My father is Gleason 9 stage 4 and was diagnosed in November. How long did it take for you to go into remission and how long have you been in Remission? .
@Richelle deJong after I had my prostate removed I went in Remission it been almost a year June 14 2022 however I am on pens and Needles Wondering I'd and when it come back I have a very aggressive type cancer
I had Gleason 6 and my PSMA PET scan showed a spot in one seminal vesicle and possibly a lymph node alongside prostate gland . What the bloody hell are you on about ?????????????????????????
Your biopsy probably missed the higher grade cancer. It does happen.