title: [Radiotherapy in node-positive prostate cancer].
abstract: BACKGROUND
  There are numerous randomized trials to guide the management of patients with localized (and metastatic) prostate cancer, but only a few (mostly retrospective) studies have specifically addressed node-positive patients. Therefore, there is uncertainty regarding optimal treatment in this situation. Current guidelines recommend long-term androgen deprivation therapy (ADT) alone or radiotherapy plus long-term ADT as treatment options.
  
  
  OBJECTIVE
  This overview summarizes the existing literature on the use of radiotherapy for node-positive prostate cancer as definitive treatment and as adjuvant or salvage therapy after radical prostatectomy. In this context, we also discuss several PET tracers in the imaging evaluation of patients with biochemical recurrence of prostate cancer after radical prostatectomy. As for definitive treatment, retrospective studies suggest that ADT plus radiotherapy improves overall survival compared with ADT alone. These studies also consistently demonstrated that many patients with node-positive prostate cancer can achieve long-term survival - and are likely curable - with aggressive therapy.
  
  
  RESULTS
  The beneficial impact of adjuvant radiotherapy on survival in patients with pN1 prostate cancer seems to be highly influenced by tumor characteristics. Men with ≤ 2 positive lymph nodes in the presence of intermediate- to high-grade disease, or positive margins, and those with 3 or 4 positive lymph nodes are the ideal candidates for adjuvant radiotherapy (plus long-term ADT) after surgery.
  
  
  CONCLUSIONS
  There is a need for randomized trials to further examine the potential role of radiotherapy as either definitive or adjuvant treatment, for patients with node-positive prostate cancer.
authors.affiliation: Fachbereich Strahlentherapie und Radioonkologie, MVZ Klinikum Esslingen GmbH, Hirschlandstraße 97, 73730, Esslingen a. N., Deutschland. d.bottke@klinikum-esslingen.de.
authors.forename: D
authors.initials: D
authors.lastname: Bottke
authors.affiliation: Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Ulm, Albert-Einstein-Straße 23, 89081, Ulm, Deutschland.
authors.forename: D
authors.initials: D
authors.lastname: Bartkowiak
authors.affiliation: Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Prittwitzstraße 43, 89075, Ulm, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Bolenz
authors.affiliation: Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Ulm, Albert-Einstein-Straße 23, 89081, Ulm, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Wiegel
mesh_terms: D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary*; D019317:Evidence-Based Medicine; D005858:Germany; D006801:Humans; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011878:Radiotherapy / Q000379:methods*; D016896:Treatment Outcome
keywords: Androgen deprivation therapy; Lymphatic metastases; Positron-emission tomography; Prostatectomy, radical; Radiotherapy, adjuvant