Radiation Therapy in Node-Positive Prostate Cancer: Current Evidence and Future Directions.

Area of Science:

• Oncology
• Radiation Oncology
• Urologic Oncology

Background:

• Node-positive prostate cancer (N1 PCa) management is debated, traditionally viewed as metastatic.
• Recent advancements in imaging and treatment have redefined the clinical relevance of N1 disease.

Purpose of the Study:

• To review current evidence and ongoing clinical trials for N1 PCa management.
• To evaluate the role of radiation therapy (RT) in both definitive and postoperative settings for N1 PCa.

Main Methods:

• Narrative review of recent literature and clinical trials.
• Focus on the impact of prostate-specific membrane antigen (PSMA) PET/CT on staging.
• Analysis of studies combining RT with androgen deprivation therapy (ADT).

Main Results:

• PSMA PET/CT improves staging accuracy, increasing RT consideration for cN1 disease.
• RT plus ADT shows improved survival over ADT alone in retrospective and prospective studies.
• Whole-pelvic RT (WPRT) with dose escalation to involved nodes is supported by robust data.

Conclusions:

• RT plays an increasing role in N1 PCa management, especially with ADT.
• Optimal management for postoperative pN1 disease requires further investigation.
• Ongoing trials are expected to refine treatment approaches for N1 PCa.