Lymph node positive prostate carcinoma. A case for radiotherapy

: The role of radiotherapy of the pelvic lymphatic pathways in patients with node positive prostate cancer remains uncertain. Interpretation of the few prospective studies (RTOG 75-06 and 77-06) is hampered by severe flaws in the study design. Extension of the radiation to the paraaortal region shows no advantage over radiation of the pelvic lymphatics alone and is not warranted. Data on longterm side-effects are only available from older studies with outdated radiation techniques. According to more recent studies short term side effects are considerably higher with radiation of the pelvic lymphatics when compared with radiation of the prostate alone. In summary radiation of the lymphatic pathways in lymph node positive prostate cancer cannot currently be considered as standard treatment and should be carried out within clinical studies.