The challenge of treating node-positive prostate cancer. An approach to resolving the questions

Abstract

Background: Prostate cancer commonly presents with positive pelvic lymph nodes. The appropriate management of patients with prostate cancer is controversial and no satisfactory randomized trials have been conducted.

Methods: Available literature was reviewed, particularly concerning long-term survival after primary surgery or radiation therapy with or without adjuvant androgen deprivation.

Results: With surgery, 10-40% of patients with low volume nodal disease are 10-year, no evidence of disease (NED) survivors and with radiation, 10-20% of node-positive patients are free of failure at 10 years. Few studies include past treatment and prostate specific antigen (PSA) data. It also appears that androgen deprivation may improve survival after surgery.

Conclusions: At least 40,000 patients of all clinical stages will have node-positive prostate cancer in 1992. A careful systematic investigation by prospective trial of the available treatment options is needed to establish the optimal management of these prostate cancers.