In an analysis of outcomes reported in the Journal of Clinical Oncology, men who were diagnosed with lymph node-positive prostate cancer (no bone involvement) who went on to receive targeted radiation (adjuvant radiotherapy) enjoyed a survival benefit over those individuals who did not have this therapy. This finding was specifically for men with both low-volume and intermediate-volume lymph node involvement irrespective of other tumor characteristics.
The study, which evaluated 1,107 men with pN1 prostate cancer who had been treated with a radical prostatectomy and anatomically extended pelvic lymph node dissection between 1988 and 2010 at the Mayo Clinic in Rochester, Minnesota, and San Raffaele Hospital in Milan. All subject men also received adjuvant hormonal therapy (ADT) with or without adjuvant radiotherapy.
Thirty five percent (35%) of the men received the adjuvant radiotherapy. The men receiving the adjuvant radiotherapy had a significantly lower risk of prostate cancer–specific mortality (death due to prostate cancer). When the researchers stratified the subject men into risk groups it showed that the survival benefit was limited to two groups of men. Those men who did have a benefit from receiving the targeted radiation were men who had two or more positive lymph nodes, Gleason score 7 to 10, pT3b/pT4 stage, or positive surgical margins (HR = 0.30, P = .002) and men with three to four positive nodes regardless of other tumor characteristics (HR = 0.21, P = .02).
In this very important study, the researchers concluded that, “The beneficial impact of [adjuvant radiotherapy] on survival in patients with pN1 prostate cancer is highly influenced by tumor characteristics. Men with low-volume nodal disease ([two or more positive lymph nodes]) in the presence of intermediate- to high-grade, non–specimen-confined disease and those with intermediate-volume nodal disease (three to four [positive lymph nodes]) represent the ideal candidates for [adjuvant radiotherapy] after surgery.”
These findings are very important as one third of us will experience some sort of recurrence of our prostate cancer after receiving primary prostate cancer treatment. Those men who have surgery and have a recurrence specifically in the lymph nodes can compare their clinical state to see if adjuvant radiotherapy might extend their life.
Alberto Briganti, MD, Journal of ClinicalOncology; Alberto Briganti.
Joel T. Nowak, M.A., M.S.W.