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

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 reas...

Some minor points that might add to the discussion.

Should adjuvant RT be given?

If the vast majority of men with pN+ disease have biochemical recurrence, then do the big randomized trials comparing adjuvant vs early salvage apply? Or should we just wait for PSA to recur and then treat?

While the ARTIS...

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) ...

These subsets were not included in all post op studies comparing early salvage vs adjuvant treatment. Published data suggest a high risk of BCR in this subset of node-positive post op patients without any adjuvant treatment. ADT alone is probably not curative. I favor adjuvant RT plus ADT unless pos...

@Dr. First Last - 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!