In the normal course of events node-positive prostate cancer has typically been excluded from clinical trials. This leaves our oncologists with little evidence to guide the management for those of us who have this flavor of prostate cancer.

A recent anaylisis presented at the European Society for Medical Oncology (ESMO) 2014 Congress begins to shed some light on the management of node positive prostate cancer. The evidence presented indicated that radiotherapy (to the pelvis and lymph nodes) added to androgen-deprivation therapy (ADT) improves survival.

In a post hoc analysis of the control arm of the phase III STAMPEDE trial it was shown that the addition of radiation to androgen-deprivation therapy prolonged failure-free survival, an endpoint that included biochemical failure, disease progression, or death, in men with high-risk prostate cancer, including both node-negative and node-positive cancers.
Radiation plus androgen-deprivation therapy should be considered standard of care for node positive prostate cancer just like it is already considered the standard of care for high-risk node-negative men.

James N, Spears M, Clarke N, et al: Impact of node status and radiotherapy on failure free survival in men with newly diagnosed non-metastatic prostate cancer: Data from >690 patients in the control arm of the STAMPEDE trial. ESMO 2014 Congress. Abstract 754O. Presented September 28, 2014.,-2014/radiotherapy-should-be-added-to-hormone-therapy-in-node-positive-prostate-cancer.aspx

Joel T. Nowak, M.A., .S.W.