Omitting Elective Pelvic Nodes Irradiation in High Risk Prostate Cancer: Report on 43 Consecutive Elderly Patients

Area of Science:

• Oncology
• Radiation Oncology
• Geriatric Oncology

Background:

• Standard treatment for high-risk prostate cancer (PC) involves radiotherapy (RT) and androgen deprivation therapy (ADT).
• The role of elective nodal irradiation (ENI) in node-negative patients is debated, especially in elderly populations.
• This study evaluates prostate-only RT (PORT) and ADT outcomes in elderly patients with high-risk PC in a real-world setting.

Purpose of the Study:

• To assess the efficacy and safety of PORT combined with ADT in elderly patients with high-risk prostate cancer.
• To evaluate oncological endpoints including Biochemical Failure-Free Survival (BFFS), Disease-Free Survival (DFS), Metastasis-Free Survival (MFS), Prostate Cancer-Specific Survival (PCSS), and Overall Survival (OS).
• To determine if PORT represents a clinically reasonable treatment de-escalation strategy for this demographic.

Main Methods:

• Retrospective analysis of 43 elderly patients (median age 76) with high-risk PC treated between 2016-2022.
• Patients received PORT (moderate hypofractionation) and ADT (median 24 months), with modern staging including PET/CT in 44.2%.
• Oncological endpoints were calculated from treatment initiation, with DFS defined as a composite of failure, recurrence, or salvage therapy.

Main Results:

• Median follow-up of 60 months yielded 100% 5- and 7-year BFFS.
• Estimated 5-year and 7-year DFS were 94.7% and 71.8%, respectively, with 9.3% experiencing radiological recurrence.
• Excellent 5- and 7-year MFS (97.6%, 88.7%), 100% PCSS, and 86.7% 5-year OS were observed, with low gastrointestinal toxicity.

Conclusions:

• PORT with long-term ADT and modern staging offers excellent disease control and safety in elderly high-risk PC patients.
• PORT appears to be a reasonable de-escalation strategy, considering the high rate of competing mortality in this population.
• Results are hypothesis-generating and require validation through prospective randomized trials.