Takaisin Tulosta

Selected studies assessing local treatment in (any cT) cN1 M0 prostate cancer patients

Additional information
EAU guideline panel
17.12.2025
Table 1. Selected studies assessing local treatment in (any cT) cN1 M0 prostate cancer patients
Study n Design Study period / follow-up Treatment arms Effect on survival
ADT = androgen deprivation therapy; CSS = cancer-specific survival; EBRT = external beam radiotherapy in standard fractionation; FFS = failure-free survival; HR = hazard ratio; mo = months; n = number of patients; OS = overall survival; RP = radical prostatectomy; RT = radiotherapy; wk = week; yr = year.
Bryant, et al.,
2018 «Bryant AK, Kader AK, McKay RR ym. Definitive Radia...»1
648 Retrospective
(National
Veterans Affairs)
2000-2015
61 mo.
ADT ± EBRT Significant benefit for
combined treatment only
if PSA levels less than the
median (26 ng/mL)
All-cause mortality HR: 0.50
CSS, HR: 0.38
Sarkar, et al.,
2019 «Sarkar RR, Bryant AK, Parsons JK ym. Association b...»2
741 Retrospective
(National
Veterans Affairs)
2000-2015
51 mo.
ADT ± local
treatment
(surgery or RT)
Significant benefit for RP
All-cause mortality HR 0.36
CSS, HR: 0.32
No statistical difference for
RP vs. RT (p ≥ 0.1)
All-cause mortality HR: 047
CSS, HR: 0.88
Lin, et al.,
2015 «Lin CC, Gray PJ, Jemal A ym. Androgen deprivation ...»3
983 before
propensity
score
matching
Retrospective
(NCDB)
2004-2006
48 mo.
ADT ± EBRT Significant benefit for
combined treatment
5-yr. OS: 73% vs. 52%
HR: 0.5
Tward, et al.,
2013 «Tward JD, Kokeny KE, Shrieve DC. Radiation therapy...»4
1,100 Retrospective
(SEER)
1988-2006
64 mo.
EBRT
(n = 397) vs.
no EBRT
(n=703)
No information
on ADT)
Significant benefit for EBRT
5-yr. CSS: 78% vs. 71%
HR: 0.66
5-yr. OS: 68% vs. 56%,
HR: 0.70
Rusthoven,et al. 2014 «Rusthoven CG, Carlson JA, Waxweiler TV ym. The imp...»5 796 Retrospective
(SEER)
1995-2005
61 mo.
EBRT vs. no
EBRT (no
information on
ADT)
Significant benefit for EBRT
10-yr. OS: 45% vs. 29%
HR: 0.58
Chierigo, et al. 2022 «Chierigo F, Borghesi M, Würnschimmel C, ym. Surviv...»9 4,685 Retrospective
(SEER)
2004-2016 RP or RT (unknown ADT status) Propensity score matching
5-yr OS: 84.6%
(RP) vs. 75% (RT), HR 0.62, p < 0.001
5-yr CSS: 90.7%
(RP) vs. 83% (RT),
HR 0.62, p < 0.001
5-yr other cause mortality, 6.1%
RP vs. 8.0% RT, HR 0.71, p = 0.04
Seisen, et al.,
2018 «Seisen T, Vetterlein MW, Karabon P ym. Efficacy of...»6
1,987 Retrospective
(NCDB)
2003-2011
50 mo.
ADT ± local
treatment
(surgery or RT)
Significant benefit for
combined treatment
5-yr. OS: 78.8% vs. 49.2%
HR: 0.31
No difference between RP
and RT
James, et al.,
2016 «James ND, Spears MR, Clarke NW ym. Failure-Free Su...»7
177 Unplanned subgroup
analysis
RCT
2005-2014
17 mo.
ADT ± EBRT Significant benefit for
combined treatment
5-yr OS: 93% vs. 71%
2-yr FFS: 81% vs. 53%
FFS, HR: 0.48
Elumalai et al. «Elumalai T, Maitre P, Portner R, ym. Impact of pro...»8 337 Retrospective 4 centres UK 2022-2019 ADT +/- EBRT Significant benefit for combined treatment
5-yr. OS: 87% vs. 56%
HR: 0.27 5-yr.
BPFS: 74.1% vs. 34.2%
HR: 0.33
James, et al. 2022 «James ND, Ingleby FC, Clarke NW, ym. Docetaxel for...»10 258 (N1 patients) Planned subgroup analysis RCT 2005-2018
81.2 mo
Standard of care (ADT +/- EBRT)
+/- docetaxel
(EBRT planned for 55% SOC, 40% of docetaxel)
5-year estimated
Metastatic PFS (SOC + docetaxel vs SOC, HR: 0.79)
OS (RT 78% vs no RT 71%, HR: 0.77)*
CSS (RT 84% vs no RT 79%, HR: 0.81)*
FFS (RT 51% vs no RT 36%, HR: 0.68)* *
No stratification for docetaxel use
Attard, et al. 2022 «Attard G, Murphy L, Clarke NW, ym. Abiraterone ace...»11 774 (N1) Planned subgroup analysis RCT 2011-2016
72 mo
Standard of care (ADT +/- EBRT) +/- Abiraterone with or without enzalutamide
(EBRT planned for 71% of N1 patients)
MFS (SOC + Abiraterone with or without enzalutamide vs SOC alone,
HR: 0.49, 95% CI: 0.38-0.64)
OS (SOC + Abiraterone with or without enzalutamide vs SOC alone,
HR: 0.53, 95% CI: 0.39-0.70)

References

  1. Bryant AK, Kader AK, McKay RR ym. Definitive Radiation Therapy and Survival in Clinically Node-Positive Prostate Cancer. Int J Radiat Oncol Biol Phys 2018;101:1188-1193 «PMID: 29891203»PubMed
  2. Sarkar RR, Bryant AK, Parsons JK ym. Association between Radical Prostatectomy and Survival in Men with Clinically Node-positive Prostate Cancer. Eur Urol Oncol 2019;2:584-588 «PMID: 31411995»PubMed
  3. Lin CC, Gray PJ, Jemal A ym. Androgen deprivation with or without radiation therapy for clinically node-positive prostate cancer. J Natl Cancer Inst 2015;107: «PMID: 25957435»PubMed
  4. Tward JD, Kokeny KE, Shrieve DC. Radiation therapy for clinically node-positive prostate adenocarcinoma is correlated with improved overall and prostate cancer-specific survival. Pract Radiat Oncol 2013;3:234-240 «PMID: 24674370»PubMed
  5. Rusthoven CG, Carlson JA, Waxweiler TV ym. The impact of definitive local therapy for lymph node-positive prostate cancer: a population-based study. Int J Radiat Oncol Biol Phys 2014;88:1064-73 «PMID: 24661660»PubMed
  6. Seisen T, Vetterlein MW, Karabon P ym. Efficacy of Local Treatment in Prostate Cancer Patients with Clinically Pelvic Lymph Node-positive Disease at Initial Diagnosis. Eur Urol 2018;73:452-461 «PMID: 28890245»PubMed
  7. James ND, Spears MR, Clarke NW ym. Failure-Free Survival and Radiotherapy in Patients With Newly Diagnosed Nonmetastatic Prostate Cancer: Data From Patients in the Control Arm of the STAMPEDE Trial. JAMA Oncol 2016;2:348-57 «PMID: 26606329»PubMed
  8. Elumalai T, Maitre P, Portner R, ym. Impact of prostate radiotherapy on survival outcomes in clinically node-positive prostate cancer: A multicentre retrospective analysis. Radiother Oncol 2023;186():109746 «PMID: 37330057»PubMed
  9. Chierigo F, Borghesi M, Würnschimmel C, ym. Survival after radical prostatectomy versus radiation therapy in clinical node-positive prostate cancer. Prostate 2022;82(6):740-750 «PMID: 35226380»PubMed
  10. James ND, Ingleby FC, Clarke NW, ym. Docetaxel for Nonmetastatic Prostate Cancer: Long-Term Survival Outcomes in the STAMPEDE Randomized Controlled Trial. JNCI Cancer Spectr 2022;6(4): «PMID: 35877084»PubMed
  11. Attard G, Murphy L, Clarke NW, ym. Abiraterone acetate and prednisolone with or without enzalutamide for high-risk non-metastatic prostate cancer: a meta-analysis of primary results from two randomised controlled phase 3 trials of the STAMPEDE platform protocol. Lancet 2022;399(10323):447-460 «PMID: 34953525»PubMed