Clinical Practice Guidelines for the management of locally advanced ...

Evidence summary Level References
Both of the two larger RCT subgroup analyses for biopsy proven
node-positive disease that were examined showed that castration,
either LHRH agonist until progression or orchidectomy, resulted in
significant overall and cancer-specific survival benefits when
combined with radiotherapy
Recommendation
II 112-114
If radical radiotherapy is given to patients with node-positive disease it is reasonable to offer
long-term androgen deprivation in addition to radiotherapy.
Grade D
3.3.2 External beam radiotherapy
There are three randomised control trials examining radiotherapy alone as a treatment option for
node-positive disease. Two of the three trials compared prostate and pelvic irradiation to para-aortic
and pelvic and prostate irradiation. 62, 63, 116 The Bagshaw trial included 18 patients and the Pilepich
trial, a subgroup analysis, included 134 patients. The third trial was also small, with 77 patients. It
compared extended field radiation in pelvic lymphadenectomy patients with observation followed by
delayed hormonal therapy. 117 None of the trials was blinded.
There were no RCTs comparing conformal modern radiotherapy techniques with immediate hormone
therapies.
The trials examining extended field with a more limited pelvic field were consistent, showing no
overall survival or disease-free survival benefit when comparing extended para-aortic irradiation to
pelvic and prostate irradiation.
There was only one trial comparing radiotherapy with no radiotherapy. 117 At five years median
disease-free survival was statistically significantly improved in the radiotherapy arm. However, the
overall survival benefit with radiotherapy was not statistically significant. The lack of statistical
significance may be due to limited follow-up.
Evidence summary Level References
The role of external beam radiotherapy in node-positive patients has
not yet been defined.
Recommendation
II 62, 63, 116,
117
There is insufficient evidence to make a recommendation for the use of external beam
radiation as alternative or adjuvant to hormone therapies in node-positive patients.
Grade N/A
39
Locally advanced disease