Related Experiment Video
Updated: May 25, 2026
A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
Published on: November 7, 2025
Elective Nodal Radiation Therapy in Localized Prostate Cancer: A Meta-Analysis
Soumyajit Roy1, Angela Y Jia1, Nicholas G Zaorsky1
1Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
Purpose:
Recently, results from National Surgical Adjuvant Breast and Bowel Project; Radiation Therapy Oncology Group; Gynecologic Oncologic Group (NRG/RTOG) 0924, the largest randomized trial to evaluate the benefit of whole-pelvic radiation therapy (WPRT) in localized prostate cancer, were presented. We conducted an aggregate meta-analysis of all phase III randomized trials to determine the impact of WPRT on oncologic outcomes.
Methods:
PubMed via MEDLINE, clinicaltrials.gov, and conference proceedings were systematically searched for randomized trials of ±WPRT in localized prostate cancer conducted between 1980 and 2025. Random-effects models were used to generate pooled hazard ratios (HRs) with 95% CIs. Heterogeneity was assessed with I2 statistics, and leave-one-out sensitivity analyses were performed. Meta-regression was performed to assess the influence of the proportion of patients with Gleason score 7 to 10, use of androgen deprivation therapy, radiation therapy dose, and field size. Endpoints assessed included overall survival, a biochemical-based endpoint, referred to as biochemical recurrence, and distant metastasis.
Results:
Four randomized trials were identified (n = 4465 patients), including 3 multicenter cooperative group trials Urogenital Tumor Study Group-French Association of Urology (GETUG-AFU-01, RTOG 9413, and RTOG 0924) and 1 single-institution trial Prostate-Only versus Whole-Pelvic Radiation Therapy (POP-RT). WPRT did not improve overall survival (HR, 1.05; 95% CI, 0.95-1.16; I2 = 0%), biochemical recurrence (HR, 0.82; 95% CI, 0.63-1.07; I2 = 76%), or distant metastasis (HR, 0.88; 95% CI, 0.58-1.34; I2 = 68%). The high rates of heterogeneity observed were due primarily to the POP-RT trial. In sensitivity analyses, excluding POP-RT heterogeneity was eliminated (HR for biochemical recurrence was 0.91 [95% CI, 0.81-1.02; I2 = 0%]; HR for distant metastasis was 1.06 [95% CI, 0.87-1.29; I2 = 0%]). Meta-regression found no significant modifying effect of any covariables assessed.
Conclusions:
This aggregate meta-analysis did not demonstrate any meaningful benefit of WPRT over prostate-only radiation therapy in unselected localized prostate cancer. Individual patient data meta-analysis is warranted to understand whether any subgroup consistently derives benefit from WPRT.
