Radiation treatment plus androgen deprivation therapy (ADT) after radical prostatectomy was associated with an overall survival benefit among patients with prostate cancer with lymph node involvement, according to a study published in Cancer.1
The management of prostate cancer with lymph node involvement after radical prostatectomy remains controversial. Although retrospective studies support the use of radiotherapy after extended pelvic lymph node dissection in select patients, the generalizability of this approach to practice is unclear.
To identify patients with lymph node involvement who could derive a survival benefit with adjuvant radiotherapy in combination with ADT, researchers analyzed data from 2569 patients with N1M0 prostate adenocarcinoma who underwent radical prostatectomy followed by ADT between 2003 and 2011.
Of those, 35.3% received radiotherapy. Patients were more likely to receive radiotherapy if they were younger than 65 years, were diagnosed in later years, had fewer positive lymph nodes, and had involved surgical margins (all P < .05).
The study showed that 87% of patients who received radiotherapy were alive at 5 years compared with 82% of those who did not undergo radiation treatment (P = .007).
In a propensity score analysis of 826 patients in each cohort, results demonstrated that receipt of radiotherapy was significantly associated with a 43% improvement in overall survival (hazard ratio, 1.43; 95% CI, 1.10-1.86; P = .008).
There was no association between the effect of radiotherapy on overall survival and total lymph nodes examined, lymph node ratio, total number of positive lymph nodes, margin status, prostate-specific antigen, or Gleason score.
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In the absence of randomized clinical trial data, these findings may help guide therapy for this subpopulation of patients with prostate cancer. Future large prospective trials are needed to validate these results.
- Jegadeesh N, Liu Y, Zhang C, et al. The role of adjuvant radiotherapy in pathologically lymph node positive prostate cancer. Cancer. 2016 Nov 8. doi: 10.1002/cncr.30373 [Epub ahead of print]