DOES PELVIC IRRADIATION PLAY A ROLE IN THE MANAGEMENT OF PROSTATE-CANCER

The optimal management of patients with lymph node-positive prostate c ancer remains controversial. The role of pelvic irradiation in patient s at high risk for nodal involvement continues to be debated. Studies of prostate irradiation with and without inclusion of the pelvic lymph nodes show poor outcomes for node-positive patients, supporting the c oncept that many of these patients have systemic disease at presentati on, Although no randomized trial has examined the role of pelvic irrad iation in pathologically node-positive patients,available data fail to reveal any significant benefit of this approach over prostate-alone i rradiation. More promising therapeutic approaches involve the combinat ion of local therapy and sustained hormonal therapy. Series comparing prophylactic irradiation of the pelvis and prostate to irradiation of the prostate alone have shown no clear benefit of pelvic irradiation. Pelvic irradiation may play a role in the treatment of early-stage or occult nodal disease, although this has yet to be examined. Until pros pective, randomized trials demonstrate the efficacy of pelvic irradiat ion in the management of prostate cancer, its use cannot be routinely recommended. Data support the use of lymphadenectomy in high-risk pati ents to identify those,vith positive nodes, since these patients requi re androgen withdrawal therapy.