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Can the Number of Positive Pelvic Lymph Nodes Guide Adjuvant Radiation Therapy for Prostate Cancer?

By: Joshua D. Madera, MS
Posted: Tuesday, August 30, 2022

For men with pN1 prostate cancer, the use of adjuvant radiation therapy as compared with standard early salvage radiation therapy significantly reduced all-cause mortality risk, according to a study published in the Journal of Clinical Oncology. The extent of risk reduction increased by 8% with each additional positive pelvic lymph node, explained Anthony V. D’Amico, MD, PhD, of Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, and colleagues.

“These findings provide evidence to support considering the use of adjuvant radiation therapy in men with pN1 prostate cancer and using a personalized approach on the basis of the number of positive pelvic lymph nodes and other comorbidities,” commented the investigators.

From 1995 to 2017, a total of 17,913 men with prostate cancer were recruited for the study. All patients had undergone radical prostatectomy and pelvic lymph node assessment. Patients were stratified into three groups: those who received no radiation therapy, those who received adjuvant radiation therapy, or those who received early salvage radiation therapy. Additionally, patients had their prostate-specific antigen levels measured.

The study findings revealed a significantly reduced all-cause mortality risk for patients who received adjuvant radiation therapy as the number of positive pelvic lymph nodes increased (hazard ratio = 0.92). Furthermore, for men with four or more positive nodes, adjuvant radiation therapy was preferred over early salvage radiation therapy, given the significant 7-year adjusted all-cause mortality risk (7.74% vs. 23.36%, respectively). For patients with one to three positive pelvic nodes, no significant difference in all-cause mortality was identified between adjuvant radiation therapy (14.27%) and early salvage radiation therapy (13.89%).

Disclosure: For full disclosures of the study authors, visit

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