How would you treat node positive (pN+) prostate cancer with undetectable post-op PSA after radical prostatectomy and pelvic LND?

Topics: Radiation Oncology • Genitourinary Cancers • Prostate Cancer • Medical Oncology

Would you offer adjuvant radiation? (Dose? Target?) vs Salvage?

Would you add ADT? Would you add abiraterone?

Would the number of lymph nodes involved influence your decision?

Answer from: Radiation Oncologist at Community Practice

The short answer is, YES I would, in general, recommend treatment. I also respectfully disagree that ADT monotherapy is the standard of care. It is an option of course, but rarely performed given it is non-curative and the data to support its use is of minimal relevance today.Some key points of...

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Radiation Oncologist at Henry Ford Hospital
Thank you very much for your answer! This was quit...

Radiation Oncologist at Lafayette Radiation Center
Decipher data support @Daniel E. Spratt's conclusi...

Answer from: Radiation Oncologist at Community Practice

The Messing trial established that these patients should be getting long term ADT (if not life-long), and though it was a small study, ADT dramatically improved survival. So, the question really is, should you add RT? There is not prospective evidence, however there is a large series (Mayo + Milan) ...

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Radiation Oncologist at Yale
Thank you for this answer! I am wondering how peop...

Answer from: Radiation Oncologist at Community Practice

@Daniel E. Spratt - What are your thoughts on the addition of Abiretarone to this patient population? The STAMPEDE trial was for intact prostate. Would insurance ever consider coverage for post-RP patients with N+ disease? Thank you!

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