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As I have discussed in several issues of my newsletter, Prostate Forum , prostate cancer usually spreads from the prostate gland to the lymph nodes in the pelvis and then to bone. However, there are occasionally men who have prostate cancer that has spread to the lymph nodes outside of the pelvis yet do not show any evidence of bone involvement. These men often have very high PSA levels. In the full version of this article that appeared in Volume 10 # 9 of Prostate Forum , the first of which was my first prostate cancer patient. This man was a homicide detective from New Orleans who had been one of the patients initially treated by Ferdinand Labrie in his "complete androgen" blockade trials. He had eventually progressed through that treatment and entered my clinical trial testing suramin as a treatment for prostate cancer. He proceeded to have a very dramatic response to suramin. In fact, his was the best response we had to that drug while I was at the National Caner Institute. Another patient I'd treated had been diagnosed years earlier at Massachusetts General Hospital with a PSA in excess of 3,000 ng/ml and widespread involvement of lymph nodes throughout his body. While he did not have bone metastases, he was in kidney failure because the lymph nodes were blocking the flow of urine down the ureters. He went on to have a spectacular response to hormonal therapy with normalization of his kidney function. Now, years after his diagnosis, he still is not hormone-resistant and does not have bone metastases. The third patient arrived at my clinic, American Institute for Diseases of the Prostate, in the fall of 2005. He had an initial PSA of 3,600 ng/ml. At that time, he had extensive pelvic and retroperitoneal lymph node involvement, but no bone metastases. We started him on an LHRH agonist, Casodex, and Avodart. After 6 months of therapy, his PSA was less than 0.01 ng/ml, but the CT scan still showed enlargement of his retroperitoneal lymph nodes. By 10 months, even the CT scan showed no evidence of disease. After one year he was taken off hormonal therapy. As his testosterone recovered, his PSA increased from less than 0.01 ng/ml to 0.1 - 0.2 ng/ml and has been stable in this range ever since. His last PSA, done 18 months after the end of hormonal therapy, remained stable and bone scan and CT scan showed no evidence of metastatic cancer. Ultrasound exam still showed cancer present within the prostate gland. To read the remainder of this article on advanced prostate cancer with only lymph node involvement as well as other articles on unusual forms of prostate cancer, visit
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