5.02.07 My Own Case: Lymph Node Involvement, Prostate Cancer Survivor, Prostate Cancer Spread To Lymph Nodes

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 Vol 8 # 12.