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Advanced
Prostate Cancer: Lymph Node Only Involvement
Febrary 16, 2009
As I have discussed in several issues of my newsletter, Prostate
Forum, prostate cancer usually spreads from the prostate
gland to the lymph nodes in the pelvis and then to bone. However,
there
are occasionally men who have prostate cancer that has spread
to the lymph nodes outside of the pelvis yet do not show any
evidence of bone involvement. These men often have very high
PSA levels. In the full version of this article that appeared
in Volume
10 # 9 of Prostate Forum I list the papers I can found
on this subject. One interesting point made by several of those
authors is that the men did unexpectedly well with hormonal therapy
with excellent initial responses and without the expected development
of hormone-resistance. During my career I have seen a number
of such cases, the first of which was my first prostate cancer
patient. This man was a homicide detective from New Orleans who
had been one of the patients initially treated by Ferdinand Labrie
in his “complete androgen” blockade trials. He had
eventually progressed through that treatment and entered my clinical
trial testing suramin as a treatment for prostate cancer. He
proceeded to have a very dramatic response to suramin. In fact,
his was the best response we had to that drug while I was at
the National Caner Institute.
Another patient I’d treated had been diagnosed years earlier
at Massachusetts General Hospital with a PSA in excess of 3,000
ng/ml and widespread involvement of lymph nodes throughout his
body. While he did not have bone metastases, he was in kidney
failure because the lymph nodes were blocking the flow of urine
down the ureters. He went on to have a spectacular response to
hormonal therapy with normalization of his kidney function. Now,
years after his diagnosis, he still is not hormone-resistant
and does not have bone metastases.
The third patient arrived at my clinic, American Institute for
Diseases of the Prostate, in the fall of 2005. He had an initial
PSA of 3,600 ng/ml. At that time, he had extensive pelvic and
retroperitoneal lymph node involvement, but no bone metastases.
We started him on an LHRH agonist, Casodex, and Avodart. After
6 months of therapy, his PSA was less than 0.01 ng/ml, but the
CT scan still showed enlargement of his retroperitoneal lymph
nodes. By 10 months, even the CT scan showed no evidence of disease.
After one year he was taken off hormonal therapy. As his testosterone
recovered, his PSA increased from less than 0.01 ng/ml to 0.1
- 0.2 ng/ml and has been stable in this range ever since. His
last PSA, done 18 months after the end of hormonal therapy, remained
stable and bone scan and CT scan showed no evidence of metastatic
cancer. Ultrasound exam still showed cancer present within the
prostate gland.
To read the remainder of this article on advanced prostate cancer
with only lymph node involvement as well as other articles on
unusual forms of prostate cancer, visit
out back issues section where you can download
Volume 10 Issue 9 of Prostate Forum. |
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