Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun;207(6):1227-1235.
doi: 10.1097/JU.0000000000002455. Epub 2022 Jan 27.

Survival Outcomes in Men with Unfavorable Intermediate-Risk and High-Risk Prostate Cancer Treated with Prostate-Only versus Whole Pelvic Radiation Therapy

Neal Andruska  1   2 , Benjamin W Fischer-Valuck  3 , Michael Waters  1   2 , Elizabeth Juarez Diaz  1 , Temitope Agabalogun  1 , Eric H Kim  2   4 , Zachary L Smith  2   4 , Randall J Brenneman  1   2 , Hiram A Gay  1   2 , Gerald L Andriole  2   4 , Jeff M Michalski  1   2 , Brian C Baumann  1   2   5
Affiliations

Survival Outcomes in Men with Unfavorable Intermediate-Risk and High-Risk Prostate Cancer Treated with Prostate-Only versus Whole Pelvic Radiation Therapy

Neal Andruska et al. J Urol. 2022 Jun.

Abstract

Purpose: Men with unfavorable intermediate-risk (UIR-PCa) or high-risk prostate cancer (HR-PCa) are often treated with definitive external beam radiotherapy (EBRT) plus androgen deprivation therapy. Treatment is frequently intensified by electively treating the pelvic lymph nodes (LNs) with whole pelvis radiotherapy (WPRT), but practice patterns and the benefits of WPRT are not well defined. We hypothesized that men treated with WPRT would have improved overall survival (OS) relative to men treated with prostate-only radiotherapy.

Materials and methods: National Cancer Database records of men diagnosed between 2008-2015 with UIR-PCa or HR-PCa and treated with prostate EBRT±androgen deprivation therapy (72-86.4 Gy) with (15,175) or without (13,549) WPRT were reviewed. Risk of LN involvement was calculated using the Memorial Sloan Kettering Cancer Center nomogram. Measured confounders were balanced with inverse probability of treatment weighting and OS hazard ratios (HRs) were generated using multivariable Cox regression.

Results: Of the men, 53% received WPRT. Every 1% increase in risk of LN involvement correlated with a 1% increase in risk of death (p <0.001). WPRT trended toward improved OS in all men with UIR-PCa and HR-PCa (HR: 0.95 [95% CI: 0.90-1.006], p=0.055). WPRT correlated with improved OS in men with Gleason 9 and 10 disease (HR: 0.87 [0.78-0.98], p=0.02) or risk of LN involvement ≥10% (HR: 0.93 [0.87-0.99], p=0.03).

Conclusions: Men with higher LN risk scores and Gleason grade benefited from WPRT. These results complement the recent POP-RT randomized trial in mostly positron emission tomography/computerized tomography-staged patients, demonstrating that a more heterogeneous population of men staged without functional imaging benefits from WPRT.

Keywords: lymph nodes; prostatic neoplasms; radiotherapy.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: BCB is on the medical advisory panel for Sanofi and Regeneron and receives honoraria for Mevion, which are outside the scope of this work. The remaining authors have nothing to disclose.

Figures

Figure 1.
Figure 1.
(A) Whole pelvis radiation therapy (WPRT) utilization from 2008–2015. (B) The proportion of patients in a given NCCN risk group having a specific LN risk score. (C) The proportion of patients receiving WPRT or hormone therapy (ADT) according to the predicted risk of pelvic lymph node (LN) involvement. Abbreviations: ADT, androgen deprivation therapy; LN, Lymph node; UIR, unfavorable intermediate-risk; WPRT, whole pelvis radiotherapy.
See this image and copyright information in PMC

Comment in

  • Editorial Comment.
    Chen WS, Roach M. Chen WS, et al. J Urol. 2022 Jun;207(6):1234-1235. doi: 10.1097/JU.0000000000002455.01. Epub 2022 Mar 14. J Urol. 2022. PMID: 35282698 No abstract available.

References

    1. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Prostate Cancer (Version 2.2021). https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Accessed September 2, 2021.
    1. Pollack A, Karrison TG, Balogh AG Jr, et al. Short Term Androgen Deprivation Therapy Without or WithPelvic Lymph Node Treatment Added to Prostate Bed OnlySalvage Radiotherapy: The NRG Oncology/RTOG 0534 SPPORTTrial. Int J Radiat Oncol Biol Phys 2018;102: 1605.
    1. Deville C, Both S, Hwang WT, et al. Clinical toxicities and dosimetric parameters after whole-pelvis versus prostate-only intensity-modulated radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 2010;78: 763. - PubMed
    1. De Meerleer G, Berghen C, Briganti A, et al. Elective nodal radiotherapy in prostate cancer. Lancet Oncol 2021;22: e348. - PubMed
    1. Amini A, Jones BL, Yeh N, et al. Survival Outcomes of Whole-Pelvic Versus Prostate-Only Radiation Therapy for High-Risk Prostate Cancer Patients With Use of the National Cancer Data Base. Int J Radiat Oncol Biol Phys 2015;93: 1052. - PubMed