KEY POINTS
- This retrospective cohort included 93 patients with hormone-sensitive prostate cancer and PET-detected pelvic and/or para-aortic nodal-only recurrence after prior curative-intent treatment. Median follow-up was 10.0 years.
- At recurrence, median PSA was 2.7 ng/mL and patients had a median of two PET-positive nodes. Thirty percent had pelvic-only disease, while 70% had common iliac and/or para-aortic involvement.
- Treatment consisted of elective nodal RT to 45–50 Gy with a simultaneous integrated boost of 50–62.5 Gy to involved nodes, combined with temporary ADT for a median of approximately 2 years.
- Overall survival at 5 and 10 years was 95% and 77%, respectively, and prostate cancer-specific survival 96% and 87%. Ten-year survival was better for pelvic-only than common iliac/para-aortic recurrence: 93% vs 70% for OS (p=0.01) and 96% vs 83% for prostate cancer-specific survival (p=0.04).
- At 5/10 years, biochemical relapse-free survival was 46%/38%, distant metastasis-free survival 54%/31%, castration-resistant prostate cancer-free survival 79%/55%, and treatment-free survival 55%/35%.
- No acute grade 3 toxicity attributable to ENRT occurred. Ten-year grade 3 GU and GI toxicity rates were 4.3% and 1.1%, respectively.
- Normal testosterone recovery above 240 ng/dL reached only 51.7% at five years, an important counseling point when combining metastasis-directed radiation strategies with prolonged temporary ADT.
CLINICAL TAKEAWAY
Elective nodal RT with a boost to PET-positive disease and finite ADT can be followed by durable survival and relatively low severe toxicity in carefully selected nodal-only recurrent prostate cancer. The decade-long follow-up is valuable, but the absence of a comparator prevents attribution of the favorable outcomes to this treatment strategy itself.