Durable Disease Control Following Multimodal Therapy in Prostate Cancer With a Massive Pelvic Lymph Node Metastasis

Prostate cancer with a massive pelvic lymph node metastasis is uncommon, and its optimal management remains uncertain. We describe the case of a 69-year-old man with a cT3aN1M0 prostate cancer and a 10 cm (175 cm³) pelvic lymph node metastasis. He received multimodal therapy consisting of androgen deprivation therapy (ADT), seven cycles of docetaxel, and external beam radiotherapy. This approach led to marked regression of the nodal disease and sustained suppression of prostate-specific antigen (PSA) to <0.01 ng/mL for longer than 14 months without additional systemic treatment. Although the therapeutic strategy deviated from current guideline-based recommendations, the case highlights that combining systemic therapy with radiotherapy can achieve durable disease control in selected patients with locally advanced prostate cancer and massive lymph node involvement.