Radiotherapy in Lymph Node-Positive Prostate Cancer Patients – A Potential Cure?

Some studies have shown that a number of patients with positive lymph nodes may be potentially curable. Seventy-five lymph node-positive prostate cancer patients were treated by radiotherapy alone (36%) or by radiotherapy after radical prostatectomy (64%). The 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. Biochemical no evidence of disease (bNED), overall survival as well as acute/late gastrointestinal and urogenital side effects were evaluated. Median follow-up was 40 months (range 1-132). Five- and eight-year bNED rates were 54% and 51%, respectively; 5- and 8-year overall survival rates were 78% and 67%, respectively. Concerning bNED and overall survival, no significant difference in regard to treatment technique (prostatic region vs. prostatic region plus pelvic lymph nodes) or treatment strategy (radical prostatectomy plus radiotherapy vs. radiotherapy alone) was found. Four of seventy-five patients showed no prostate-specific antigen progression after 9 years. Acute/late gastrointestinal and urogenital side effects were mostly moderate, revealing no difference in severity regarding treatment technique. To conclude, advanced treatment techniques allowing dose escalation in the prostatic and pelvic region should be considered in selected lymph node-positive prostate cancer patients in order to further improve clinical outcome.