No Surgery if Positive Lymph Nodes?
Dear OncoLink "Ask The Experts,"
Why is a prostate cancer surgery stopped if the cancer is found in the lymph nodes? Why can't the lymph nodes be removed along with the prostate?
Alan J. Wein, MD, Professor and Chair of the Division of Urology at the University of Pennsylvania School of Medicine, responds:
The finding of positive lymph nodes during prostate surgery means that the disease has already spread outside the prostate, and thus is locoregionally advanced (located in the body beyond the prostatic area). When disease is locoregionally advanced, there is also the potential for it to be micrometastatic (spread throughout the body, especially to the bones in the case of prostate cancer), and thus local treatment alone is not sufficient. In the presence of involved lymph nodes, almost all agree that bulk-reducing surgery (surgery to remove the "bulk" of the tumor, in this case prostatectomy) is not indicated. This is assuming that there are not other active medical issues which warrant prostate resection for palliation.
The only exception is in a young person with a single - or at most 2 -positive lymph nodes. Some feel that there is a small biological advantage in removing the prostate under these circumstances. This is different from, say, kidney cancer, in which bulk-reducing surgery in a patient with a good performance status is generally felt to be beneficial, regardless of nodes.