New-generation imaging techniques and the increasing use of surgery in high-risk prostate cancer (PCa) allow us to detect many cases of nodal disease at initial diagnosis or after resection. The treatment of PCa with pathologic regional nodes has evolved from the exclusive use of systemic therapy to its combination with locoregional treatment. It can also represent a benefit in the overall survival. However, the evidence from randomised studies is limited. Thus, we review the most relevant results in this scenario.
A literature search was conducted in MEDLINE, PubMed, EMBASE, Clinical-Trials.gov and Web of Science on January 2023 to review node-positive PCa by considering the relevant literature on this topic published with no restrictions on date and language. The search keywords used were "Prostatic Neoplasms" (MeSh) and "Node-positive" (Text Word) and "Radiotherapy" (MeSh) and ("Androgen Antagonists" (MeSh) or "Antineoplastic Agents, Hormonal" (MeSh)), which are indexed within the Medical Subject Headings database.
The management of node-positive PCa has no clear definitive consensus at the initial disease diagnosis or after surgery. However, in this review, we summarise the existing literature for the management of these patients in both scenarios, considering imaging tests, radiotherapy, hormone therapy and second-generation hormonal treatments.
The combination of radiotherapy and androgen-deprivation therapy is the treatment of choice. The addition of second-generation hormone therapy, plus the intensification of radiotherapy schedules, will likely change the treatment paradigm for these patients.
Archivos espanoles de urologia. 2023 Dec [Epub]
Enrique Amaya, Eliseo Carrasco, Marta López, María Antonia Gómez-Aparicio, Lira Pelari-Mici, Victor Duque-Santana, Juan Zafra, Veráne Achard, Paul Sargos, Fernando López Campos, Felipe Couñago
Department of Radiation Oncology, Rey Juan Carlos University Hospital, 28933 Madrid, Spain., Department of Radiation Oncology, Central de la Defensa Gómez Ulla University Hospital, 28047 Madrid, Spain., Department of Radiation Oncology, Puerta de Hierro Majadahonda University Hospital, 28222 Madrid, Spain., Department of Radiation Oncology, Toledo University Hospital, 45007 Toledo, Spain., Department of Radiation Oncology, Ramón y Cajal University Hospital, 28034 Madrid, Spain., Department of Radiation Oncology, Quironsalud Madrid University Hospital, 28223 Madrid, Spain., Department of Radiation Oncology, Virgen de la Victoria University Hospital, 29010 Málaga, Spain., Department of Radiation Oncology, Geneva University Hospitals, 1205 Geneva, Switzerland., Department of Radiation Oncology, Institut Bergonié, 33076 Bordeaux, France., Department of Radiation Oncology, GenesisCare Madrid Clinical Director, San Francisco de Asis and La Milagrosa Hospitals, National Chair of Research and Clinical Trials, GenesisCare, 28043 Madrid, Spain.