The general belief is that lymph-node positive prostate cancer patients are not curable. However, there has been some recent studies that argue against this assumption.
In a study at the Department of Radiotherapy and Radiobiology Medical School, University of Vienna, Vienna , Austria seventy-five lymph node-positive prostate cancer patients were treated by radiotherapy alone (36%) or by radiotherapy after radical prostatectomy (64%). In the study 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.
They then evaluated the rate of biochemical no evidence of disease (bNED), overall survival as well as acute/late gastrointestinal and urogenital side effects. The median follow-up on the men was 40 months with a range of 1 to 132 months. The five- and eight-year bNED rates were 54% and 51%, respectively; 5- and 8-year overall survival rates were 78% and 67%, respectively.
There was no significant difference in bNED and overall survival despite the treatment technique or method used to treat the prostate cancer. Out of the seventy-five patients only four had no PSA progression after 9 years of monitoring. There were some acute/late gastrointestinal and urogenital side effects, but they were moderate, revealing no difference in severity regarding treatment technique.
The researchers concluded, that the use of radiotherapy with men who have lymph node positive prostate cancer can provide the potential to cure their cancer and should be considered as a treatment modality. They did not discuss or examine whether or not positive lymph-nodes as a part of a recurrence could also provide a potential cure. This should be a next area for evaluation.
Front Radiat Ther Oncol. 2008;41:68-76.
Joel T Nowak MA, MSW