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What to Know About Lymph Node Biopsies: How to Tell if Prostate Cancer Has Spread

Prostate cancer that has spread needs to be treated differently than if it hasn't spread. For instance, men whose cancer has spread usually do not have surgery to remove the prostate. So before you can begin your treatment, your doctor needs to learn whether or not your cancer has spread.

Your Gleason score and PSA levels can help your doctor know the chances of whether your cancer has spread. For example, if your doctor has a reason to suspect that the cancer may have spread (such as a PSA level over 20 or a Gleason score over 7), your doctor may order imaging tests, such as a CT or MRI scan. If one of these tests shows enlarged lymph nodes near the prostate, the doctor will likely recommend that you have some of these lymph nodes removed and checked for cancer.

The best way to check the lymph nodes for cancer is to remove them through surgery. Removing the lymph nodes is called lymph node dissection. It is also called lymph node biopsy. Once they are removed, a pathologist looks at them under a microscope to check for cancer.

When you have the lymph nodes removed depends on the type of treatment you are having. If you are having surgery to treat your cancer, you may have the lymph nodes removed at the same time. Your doctor will remove the lymph nodes and have the pathologist look at them immediately. If they show cancer, your doctor may stop the surgery there and not remove your prostate. But some surgeons will go ahead and remove the prostate if there are only small amounts of cancer in the lymph nodes, so you should talk about this with your doctor before you have surgery. If the lymph nodes don't show cancer, your doctor can continue the surgery and remove your prostate. If you are being treated with radiation therapy, the lymph nodes may be sampled beforehand with a less invasive type of surgery known as a laparoscopic lymph node dissection. For this approach, small incisions are made in the abdomen, and long, thin surgical instruments are inserted to see inside the abdomen and pelvis and to remove the lymph nodes.