Treating Lymph Node Metastases #ProstateCancer | #MarkScholzMD | #AlexScholz #PCRI

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?

Who we are:

The information on the Prostate Cancer Research Institute's YouTube 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

[colemant]

Alex, Again... THE BEST Questions Asked and the Best Dr. answering them. Well Done. Thank You! You are helping millions of men.

[DonnaFox]

Always check for LVI. Major factor whether cancer will spread… usually around the 2 year mark it’s full blown metastases throughout body….

[tnvol]

What about a singular non enlarged lower abdominal lymph node metastasis?

[trailrider]

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!!!

[kevinvitale]

Love these conversations/discussions by Alex and Dr. Scholz. Thank you so much for understandable language.

[roboodonnell]

Thanks! You folks are very much appreciated!

[edmundpeshall]

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.

[LarsSchaferVP]

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. ;-)

[dwmcever]

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.

[stevemolyneux-ek]

Fantastic, just diagnosed with lymph node metassis very helpful

[frankmoen]

EXCELLENT many thanks Dr. Scholz and Alex

[jazandriz]

Thanks this video made me feel better.

[marketsqueezer]

T3b, Gleason=4+3, now spread to my lymph nodes, I will use my own strategy.

[robertmonroe]

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).

[cloudsculptor]

Excellent info.
What’s your take on the mitochondrial link to cells turning cancerous?

[robbujold]

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.

[mikerose]

Thanks for an excellent discussion about lymph nodes.

[SharonSmith-ipkr]

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. 😢🙏🙏

[stevemolyneux-ek]

Psa went down to 1.7 after sabre treatment then to 1.5 but last test up to 1.6

[lsu]

as always great videos. Where does he get those ties???