Abstract
Prostate cancer is the secondary most frequently diagnosed cancer in the world. Although numerous prospective randomized trial have been conducted to guide the management of patients with localized or locally advanced prostate cancer, few clinical trials targeting node-positive prostate cancer have been reported. Therefore, there are still controversies in the optimal management of node-positive prostate cancer. Recently, efficacy of multimodality treatment, including radiation therapy (RT), for such patients has been reported in several articles. The results indicate potential benefit of RT both in adjuvant therapy after prostatectomy and in definitive therapy for node-positive prostate cancer. The aim in this article was to summarize the current evidence for RT and evaluate the role in multimodality treatment for patients with node-positive prostate cancer.
Highlights
Prostate cancer is the second most frequently diagnosed cancer in men and 1.1 million new cases are estimated to have occurred in the world
Numerous randomized trials have been conducted to guide the management of patients with localized prostate cancer, few clinical trials target at patients with node-positive prostate cancer have been reported
At median follow-up of 11.9 years, men assigned immediate androgen deprivation therapy (ADT) had a significant improvement in overall survival (OS) (Hazard ratio [HR] 1.84, 95% confidence interval [CI]: 1.01-3.35, p=0.04), cancer-specific survival (CSS) (HR 4.09, 95% CI: 1.76-9.49, p=0.0004) and progression-free survival (PFS) (HR 3.42, 95% CI: 1.965.98, p
Summary
Prostate cancer is the second most frequently diagnosed cancer in men and 1.1 million new cases are estimated to have occurred in the world. Adjuvant treatment for pathologically node-positive patients after RP androgen deprivation therapy (ADT). Adjuvant ADT is considered to be the standard treatment for patients with pathologically node-positive prostate cancer after RP and PLND. Compared with standard care alone, bicalutamide significantly reduced the risk of objective progression, irrespective of lymph node status, with the most pronounced reduction in patients with node-positive disease (HR 0.29, 95% CI 0.15-0.56) compared with those with N0 (HR 0.59, 95 % CI: 0.48-0.73) and Nx (HR 0.60, 95 % CI: 0.50-0.72) disease. Kunath et al (2013) conducted a systematic review to determine the benefits of early (at the time of local therapy) versus deferred (at the time of clinical disease progression) ADT for patients with node-positive prostate cancer after local therapy. ADT lead to a significant decrease in overall mortality (OM) (HR 0.62, 95% CI: 0.46-0.84), cancer-specific mortality (CSM) (HR 0.34, 95% CI: 0.18-0.64), and clinical progression at 3 or 9 years (Risk ratios [RR] 0.29, 95% CI: 0.16-0.52 at 3 years and RR 0.49, 95% CI: 0.36-0.67 at 9 years)
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