Hostname: page-component-848d4c4894-2xdlg Total loading time: 0 Render date: 2024-06-15T20:18:28.007Z Has data issue: false hasContentIssue false

Pelvic lymph node recurrence in high-risk prostate cancer following prostate-only radiotherapy

Published online by Cambridge University Press:  17 December 2021

Sameed Hussain*
Combined Military Hospital, Rawalpindi, Punjab, Pakistan
Muhammad Imran Wajid
Combined Military Hospital, Rawalpindi, Punjab, Pakistan
Muhammad Omer
Combined Military Hospital, Rawalpindi, Punjab, Pakistan
Muhammad Yousuf Khan
Combined Military Hospital, Rawalpindi, Punjab, Pakistan
Talha Maqsood
Combined Military Hospital, Rawalpindi, Punjab, Pakistan
Adnan Zeb
Combined Military Hospital, Rawalpindi, Punjab, Pakistan
Author for correspondence: Sameed Hussain, Combined Military Hospital, Rawalpindi, Punjab, Pakistan. Email:



High-risk prostate cancer is the most common presentation at our institute among patients with non-metastatic prostate cancer. Traditionally, pelvic lymph nodes were given a prophylactic dose of radiotherapy while the prostate was given a curative dose of radiation. This study aims to evaluate patterns of failure in patients who had prostate-only radiation at our centre.

Materials and Methods:

All high-risk prostate cancer patients who underwent radical radiotherapy to prostate only since 2014 were retrospectively analysed. Local T stage, baseline prostate-specific antigen (PSA) and Gleason score were recorded. Bone scan and staging CT scan data were collected. Various dose levels prescribed to prostate were analysed. The follow-up records of these patients were assessed. Patients who failed in pelvic lymph nodes were recorded separately. Overall survival and failure-free survival were calculated using Kaplan–Meier curve.


One-hundred five patients fulfilling the inclusion criteria were analysed. Only three patients developed recurrence in pelvic lymph node following prostate-only radiotherapy (PORT). Five year overall survival was 77% while failure-free survival was 64%. Forty patients had a PSA failure after a median follow-up of 62 months.


Most high-risk prostate cancer patients who progress following hormone therapy and PORT have metastases outside pelvis. Till further conclusive evidence is available PORT can be considered as a safe option.

Original Article
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Stavrinides, V, Parker, CC, Moore, CM. When no treatment is the best treatment: active surveillance strategies for low risk prostate cancer. Cancer Treat Rev 2017; 58: 1421 doi: 10.1016/j.ctrv.2017.05.004 CrossRefGoogle Scholar
Schroder, FH, Hugosson, J, Roobol, MJ, et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow up. Lancet 2014; 384 (9959): 20272035. doi: CrossRefGoogle ScholarPubMed
D’Amico, AV, Whittington, R, Malkowicz, SB, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. J Am Med Assoc 1998; 280: 969974.CrossRefGoogle ScholarPubMed
National Comprehensive Cancer Network Guidelines for Prostate Cancer. Assessed on 30th April 2021.Google Scholar
Roach, M, DeSilvio, M, Lawton, C, et al. Phase III trial comparing whole-pelvic versus prostate-only radiotherapy and neoadjuvant versus adjuvant combined androgen suppression: Radiation Therapy Oncology Group 9413. J Clin Oncol 2003; 21 (10): 19041911. doi: 10.1200/JCO.2003.05.004 CrossRefGoogle ScholarPubMed
Pommier, P, Chabaud, S, Lagrange, JL, et al. Is there a role for pelvic irradiation in localized prostate adenocarcinoma? Update of the long-term survival results of the GETUG-01 randomized study. Int J Radiat Oncol Biol Phys 2016; 96 (4): 759769. doi: 10.1016/j.ijrobp.2016.06.2455 CrossRefGoogle Scholar
Pommier, P, Chabaud, S, Lagrange, JL, et al. Is there a role for pelvic irradiation in localized prostate adenocarcinoma? Preliminary results of GETUG-01. J Clin Oncol 2007; 25 (34): 53665373. doi: 10.1200/JCO.2006.10.5171 CrossRefGoogle Scholar
Breyer, BN, Greene, KL, Dall’Era, MA, Davies, BJ, Kane, CJ. Pelvic lymphadenectomy in prostate cancer. Prostate Cancer Prostatic Dis 2008; 11 (4): 230324.CrossRefGoogle Scholar
Onjuka, E, Uzan, J, Baker, C, Howard, L, Nahum, A, Syndikus, I. Twenty fraction prostate radiotherapy with intra-prostatic boost: results of a pilot study. Clin Oncol 2017; 29: 614.CrossRefGoogle Scholar
Hegeman, SN, Guckenberger, M, Belka, C, Ganswindt, Ute, Manapov, F, Li, M. Hypofractionated radiotherapy fpr prostate cancer. Radiat Oncol 2014; 9 (275). CrossRefGoogle Scholar
Tree, AC, Alexander, EJ, Van As, NJ, Dearnaley, D, Khoo, V. Biological dose escalation and hypofractionation: what is there to be gained and how will it best be done? Clin Oncol (R Coll Radiol) 2013; 25: 483498.CrossRefGoogle Scholar
Amin, HB, et al. AJCC Cancer Staging Manual, 8th Edition. Switzerland: Springer International Publishing, 2017.CrossRefGoogle ScholarPubMed
Dearnaley, D, Syndikus, I, Mossop, H, et al. Conventional versus hypofractionated high dose intensity-modulated radiotherapy for prostate cancer: 5 year outcomes of the randomised, non-inferiority, phase 3 CHHIP trial. Lancet Oncol 2016; 17 (8): 10471060. doi: 10.1016/S1470-2045(16)30102-4 CrossRefGoogle Scholar
Matthew, C, Abramowitz, MC, Tiaynu Li, T, et al. The Phoenix definition of biochemical failure predicts for overall survival in patients with prostate cancer. Cancer 2008; 112 (1): 5560. CrossRefGoogle Scholar
Sweeney, CJ, Chen, YH, Carducci, M, et al. Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med 2015; 373: 737746. doi: 10.1056/NEJMoa1503747 CrossRefGoogle ScholarPubMed
Parker, CC, James, ND, Brawley, CD, et al. Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial. Lancet 2018; 392 (10162): 23532366. doi: CrossRefGoogle Scholar
Murhy, V, Maitre, P, Kannan, S, et al. Prostate-only versus whole-pelvic radiation therapy in high-risk and very high-risk prostate cancer (POP-RT): outcomes from phase III randomized controlled trial. JCO 2021; 39 (11): 12341242. doi: 10.1200/JCO.20.03282CrossRefGoogle Scholar
Vargas, CE, Galalae, R, Demanes, J, et al. Lack of benefit of pelvic radiation in prostate cancer patients with a high risk of positive pelvic lymph nodes treated with high-dose radiation. Int J Radiat Oncol Biol Phys 2005; 63 (5): 14741482. doi: 10.1016/j.ijrobp.2005.04.026. Epub 2005 Jun 20.CrossRefGoogle ScholarPubMed