Localized PCa: 1 in 4 low-risk patients undergoes PLN-RT

  • Weiner AB & al.
  • Urol Oncol
  • 2 Jan 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • About 26% of patients with low-risk localized prostate cancer (PCa) and 34% of those with favorable intermediate-risk disease received pelvic lymph node irradiation (PLN-RT) while undergoing external beam radiotherapy (EBRT) during 2005-2015.
  • Use of PLN-RT increased in patients with high-/very high-risk disease.

Why this matters

  • National Comprehensive Cancer Network guidelines do not recommend PLN-RT in low- and favorable intermediate-risk patients.

Study design

  • Study of 197,378 men with localized prostate cancer from the National Cancer Database who received EBRT±brachytherapy and androgen deprivation therapy during 2005-2015.
  • Funding: NIH; Prostate Cancer Foundation.

Key results

  • 36.7% of patients received PLN-RT.
  • During 2005-2015, PLN-RT use
    • increased in men with high-risk (44.6% to 50.3%; P<.001 and very high-risk to p disease.>
    • remained stable in low-risk (27.3% to 25.6%; P=.170) favorable intermediate-risk (33.2% to 33.7%; P=.6), and unfavorable intermediate-risk (36.5% to 36.8%; P=.8) disease.
  • Significant predictors of PLN-RT:
    • very high risk disease (OR, 1.34; P=.013),
    • higher Gleason grade group (OR for group 5 vs 1, 2.08; P<.001>
    • increasing pretreatment PSA (OR, 1.09; P<.001>
    • Hispanic ethnicity (vs white men; OR, 1.29; P=.033),
    • treatment at an academic facility (vs community; OR, 0.75; P=.036).

Limitations

  • Retrospective design.