Treatment Patterns and Outcomes in Lymph-Node-Positive (pN1) Prostate Cancer: A National Cancer Database Study

Andrea Piccolini ¹, Stephan M Korn ², Zhiyu Qian ³

¹Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
²Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, Medical University of Vienna, Vienna, Austria.
³Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
⁴Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, Medical University of Graz, Graz, Austria.
⁵Avedisian School of Medicine, Boston University Chobanian, Boston, MA.
⁶Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
⁷Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA.
⁸Department of Urology, University of Pittsburgh, Pittsburgh, PA.

⁰Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.

Clinical Genitourinary Cancer +

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August 29, 2025

View abstract on PubMed

Summary

Management of prostate cancer with lymph node involvement (pN1) varies. Combining androgen-deprivation therapy with adjuvant radiotherapy significantly improves overall survival, yet is underutilized.

Area Of Science

Urology
Oncology
Cancer Research

Background

Lymph node involvement (pN1) after radical prostatectomy indicates a poorer prognosis for prostate cancer.
Optimal post-surgical management for pN1 prostate cancer remains a subject of debate.
This study evaluates treatment patterns and oncologic outcomes in pN1 prostate cancer patients.

Purpose Of The Study

To analyze treatment patterns and overall survival (OS) in men with pN1 prostate cancer.
To identify predictors of treatment selection in this patient cohort.
To assess the impact of different treatment strategies on oncologic outcomes.

Main Methods

Analysis of data from the National Cancer Database (NCDB) for pN1 patients (2010-2020).
Exclusion of patients with distant metastases or delayed adjuvant therapies.
Use of Inverse Probability of Treatment Weighting (IPTW) for survival analysis.

Main Results

Over 13,000 pN1 patients were analyzed; 51.2% received observation, 17.8% ADT alone, 26.9% ADT plus aRT, and 4.1% aRT alone.
Treatment intensification was linked to higher ISUP grade, pT3-4 disease, and nodal burden.
Androgen-deprivation therapy combined with adjuvant radiotherapy significantly improved OS (HR: 0.78, P < .001).

Conclusions

Significant variability exists in the postsurgical management of pN1 prostate cancer.
Adjuvant radiotherapy, often combined with ADT, is associated with improved survival but received by less than a third of eligible patients.
Individualized, multidisciplinary approaches are recommended for managing pN1 disease.

Keywords:

Adjuvant radiotherapy Androgen deprivation therapy Lymph node invasion Oncologic outcomes Prostate cancer

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