The role of whole pelvic radiotherapy in locally advanced prostate cancer.
Routine PSA testing has led to diagnosis and treatment of prostate cancer at earlier stages than previously. Earlier and technically-improved treatment, together with escalation of dose has enhanced cure rates. Although, the incidence of nodal metastases is now lower than in pre-PSA days, more extended pelvic lymphadenectomies have shown the actual rate of lymph node involvement to be higher than had been determined from standard radical prostate surgery. As in cancers in other sites, especially in their earlier stages, lymph node metastases may exist in the absence of haematogenous dissemination. This, together with the improved rates of control of the primary prostate tumour, suggests that elective irradiation of early-stage lymph nodes from prostate cancer should enhance survival in a manner analogous to improvements seen with this approach in other cancers. Although, the absolute incidence of positive nodes in locally advanced prostate cancer warrants elective radiotherapy, it is relatively low and the modest improvements to be expected may be undetected in the results of a small trial.
Dirix
Piet
P
Department of Radiation Oncology, University Hospital Gasthuisberg, Leuven, Belgium.
Haustermans
Karin
K
Junius
Sara
S
Withers
Rodney
R
Oyen
Raymond
R
Van Poppel
Hendrik
H
D000230:Adenocarcinoma / Q000532:radiotherapy; D014408:Biomarkers, Tumor / Q000032:analysis; D002986:Clinical Trials as Topic; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D010388:Pelvis; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000145:classification / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D011880:Radiotherapy Planning, Computer-Assisted; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen