The general belief is that lymph-node positive prostate cancer patients are not curable. However, there has been some recent studies that argue against this assumption.
In a study at the Department of Radiotherapy and Radiobiology Medical School, University of Vienna, Vienna , Austria seventy-five lymph node-positive prostate cancer patients were treated by radiotherapy alone (36%) or by radiotherapy after radical prostatectomy (64%). In the study prostatic region was irradiated in 20 patients (27%) and the prostatic region plus pelvic lymph nodes in 55 (73%). The median lymph node dose was 46 Gy, the median dose at the prostatic region 67 Gy.
They then evaluated the rate of biochemical no evidence of disease (bNED), overall survival as well as acute/late gastrointestinal and urogenital side effects. The median follow-up on the men was 40 months with a range of 1 to 132 months. The five- and eight-year bNED rates were 54% and 51%, respectively; 5- and 8-year overall survival rates were 78% and 67%, respectively.
There was no significant difference in bNED and overall survival despite the treatment technique or method used to treat the prostate cancer. Out of the seventy-five patients only four had no PSA progression after 9 years of monitoring. There were some acute/late gastrointestinal and urogenital side effects, but they were moderate, revealing no difference in severity regarding treatment technique.
The researchers concluded, that the use of radiotherapy with men who have lymph node positive prostate cancer can provide the potential to cure their cancer and should be considered as a treatment modality. They did not discuss or examine whether or not positive lymph-nodes as a part of a recurrence could also provide a potential cure. This should be a next area for evaluation.
Front Radiat Ther Oncol. 2008;41:68-76.
Joel T Nowak MA, MSW
Is the stopping Testosterone by hormone shots a successful way to stop cancer spread from the prostate to lynph nodes?
ADT does not cure prostate cancer, it temporarily tamps it down and allows some short term control. Eventually, the prostate cancer tumor generates its own testosterone which will continue to fuel the tumor even if the anti-androgen therapy brings the level of circulating testosterone to castrate levels.
Hi Joel, I was diagnosed with pc in 2014 with psa of 15.5 and biopsy concluded that cancer was present in all 10 cores with 95% involvement on the right and 38% on the left. The Gleason score was 4+3 and clinical stage was T2C. I had a robotic radical radical prostatectomy in Febuary 2015 and pathology upgraded to pt3bpn1 with spread to adipose tissue around seminal vesicles unilaterally and both seminal vesicles widely invaded. There was also positive basil margin over 5 mm and close circumferential margin at 0.1 mm. There were also positive regional lymph nodes, 1 of 6 on the right and and 2of 3 on the left. The Gleason was still 4+3 but with teritary 5 and the main focus of the tumour was 36 *33* 30 mm. I had adjuvant radiotherapy to the prostate bed and lymph nodes that finished in November 2015 and am on Prostap 11.25 mg for 2 years to be completed in June 2017. At present my psa is <0.1. My oncologist originally said that my treatment was to control pc for longer when I signed the consent forms, but has now said that it was for intent to cure. How realistically do you think that a cure is possible? I personally don't think it is and expect recurrance at some point in the future.I am not being negative and am positive in all aspects of my treatment but appreciate an honest prognosis so I can n plan my future. Any thoughts on this would be most appreciated. Kind regards, David Wilcox
Dave, my personal belief is that cancer is never curable. However, it is often very controllable. My belief is that to goal of cancer treatment is to push it into a long term remission or a chronic illness. For many, including prostate cancer this is very achievable.
Prostate cancer is a very heterogenous disease, so it is really impossible to point to an individual and say what will be an individual’s specific prognosis.
What is really important to know is that there are a huge number of us who live for years and years with more advanced Prostae cancer then you described. I am a god example being metastatic now for over ten years. In this case, I am not an outlyer. I also can tell you that there are an extraordinary number of me like me who have been alive for 15 and 20 years.
What is important is that you spend all the time you need to educate yourself so that you make the best possible treatment choices so that you join our ranks.
Continue to follow the blog, read our web page, join our Health Unlocked advanced prostate cancer online support group and listen to my podcasts.