 |
|
My
Own Case: Prostate Cancer & Lymph Node Involvement
May 2, 2007
My own battle with prostate cancer illustrates the issues surrounding
lymph node involvement. When I was diagnosed in February 1999
I had a Gleason grade of 7 (3+4) and a PSA of 20.4 ng/ml. Furthermore,
my health care team quickly found that the cancer had spread
to my seminal vesicles and to the lymph nodes in my pelvis. Of
even greater concern, the ProstaScint scan detected a potentially
abnormal node in the back of my abdomen, suggesting that the
cancer had spread beyond the pelvis. For this reason, I took
the added step of looking for cancer cells in my blood and bone
marrow. We used a technique that was not approved for clinical
use, but which is widely used in research laboratories: the RT-PCR
for prostate specific antigen (PSA) and prostate specific membrane
antigen (PSMA). RT-PCR identifies cells that are making PSA and
PSMA. The test operates on the assumption that if you find prostate
cells in the bone, blood, or lymph nodes, the cells are probably
cancerous simply because normal prostate cells would never find
their way to these locations. RT-PCR can detect one cancer cell
in one million normal cells, so it is quite sensitive. Using
this approach, my friend Dan Theodorescu detected cancer cells
in my blood and in bone marrow obtained from both sides of my
pelvis. Interestingly, RT-PCR still remains a research tool not
approved for the detection of metastatic prostate cancer. Why?
Because so far, many men with prostate cancer cells in their
bone marrow and blood have remained free of any detectable cancer
for years. As you learned in our last issue, these men may well
have been lucky enough to have cancer cells that remained dormant.
Faced with lymph node involvement, I decided to do whatever I
could to eliminate the cancer in my lymph nodes. Because of the
potentially abnormal lymph node at the back of my abdomen, I
had a surgeon remove all of the lymph nodes he could find from
the level of my kidneys to the point where the abdomen ends and
the pelvis starts. By 1999 several papers had already been published
on the use of radiation therapy to treat the lymph nodes in the
pelvis, especially those along the iliac arteries. While the
advantage of this approach remains controversial, I decided the
potential benefits far outweighed any possible risk. For the
cancer cells in my prostate gland and seminal vesicles, I elected
to have 3D-conformal radiation therapy plus radioactive seed
implantation. I topped all this off with eighteen months of Lupron,
Casodex, and Proscar. After those eighteen months, I remained
on Calcitriol and Proscar—until Avodart arrived to replace
the Proscar because of its efficacy in blocking dihydrotestosterone
as well as testosterone.
Now, eight years after the diagnosis, my PSA remains undetectable
by the PSA ultra assay and I seem to be in complete remission.
Note that I do not use the word cure. I don’t regard myself
as cured, but simply in remission. I think it very likely that
dormant prostate cancer cells remain in my body in numbers too
small to detect. I will always be at risk for recurrence, but
continue to stack all the cards in my favor to prevent this.
To read more about lymph node staging, click
here to purchase
Volume 8 Issue 12. |
|
|
|
