Prophylactic irradiation of pelvic lymph nodes in patients with high risk of prostate cancer progression: a review

One way to enhance the effectiveness of treatment for high-risk prostate cancer is to use combined hormonal/radiation therapy. The effectiveness of this approach has already been demonstrated and confirmed. The study results show that application of the hormonal therapy potentiates the total radiation effect and makes 5-year local control is more effective compared with the control achieved after application of EBRT modality. At the same time, if high dose radiation therapy is applied or large volume to be exposed to radiation, in both cases there is increased risk of radiation-induced side effects development. The radiation-related complications affect patients’ quality of life significantly. A natural question arises in such a case, whether inclusion of lesion free pelvic lymph nodes (N0) in patients with high risk of prostate cancer progression in the area of radiation exposure is necessary, if no data on their lesion (N0) are available and thus to increase the irradiated volume significantly. The considered published studies devoted to the problem were considered, the most part of the studies a retrospective, results of some studies contradicted conclusions. This does not allow us to find definitive answer to the “natural” question. Until now, it is also unknown what criteria are to be used for deciding whether radiotherapy to the area of regional metastasis zones is necessary. In this connection, it would be reasonable to conduct a prospective randomized study, its results will possibly allow us to assess the need for prophylactic irradiation of the pelvic lymph nodes during combined modality radiotherapy for high risk prostate cancer patients.