What is your management strategy for patients with positive lymph nodes after radical prostatectomy?

There is a good retrospective study from Milan that shows considerable benefit to postoperative radiation therapy for node postive patients. DaPozza et al published this in "European Urology 55 (2009) 1003–1011". Their conclusions state: "Our data showed excellent long-term outcome for node-positive PCa patients treated with radical surgery plus adjuvant treatments. This study is the first to report a significant protective role for adjuvant RT in BCR-free survival and CSS of node-positive patients."

There is no good prospective data regarding role of radiation therapy in this setting. They get androgen ablation and then case by case, we discuss the pros and cons of RT and tend to favor RT in younger patients or patients in whom pathology suggests a higher risk of local failure.