Treatment of prostate cancer with regional lymph node (N1) metastasis

Prostate cancer with pathologically documented regional lymph node positive disease has been associated with a dismal prognosis in the past. Clinical and/or biochemical progression is evident within 5 years in over 50% treated with external-beam radiotherapy (EBRT) alone, radical prostatectomy (RP) alone, or androgen deprivation (AD) alone. By 10 years after treatment, greater than 75% progress and over half succumb to prostate cancer. In contrast, the results with the combination of EBRT + AD or RP + AD have been very promising. Ten-year biochemical progression and overall survival rates are roughly 20% and 70%, respectively, for patients with subclinical lymph node involvement. Patients with a 10-year life expectancy should be treated aggressively with long-term AD combined with either EBRT or RP.