Treatment for node positive prostate cancer can vary from palliation to radical therapy. Guidance for N1 prostate cancer is unclear but evidence supports a multimodal approach including radical radiotherapy, hormonal manipulation and possible surgery while a survival benefit for neoadjuvant docetaxel has been demonstrated. Recent improvements in diagnostic techniques and technical advances in radiation therapy including intensity modulated radiotherapy (IMRT) which is capable of delivering a radical dose of radiation to pelvic nodes within acceptable toxicity profiles are anticipated to result in an increased use of radiation in this patient population. This study assesses changes in treatment modality for N1 prostate cancer over time to reflect real world practice.
Patient data from 17,695 prostate cancer cases taken from a cross-sectional survey of physicians in France, Germany, Italy, Spain, UK, China, Japan and S. Korea between Jan 1997 – Dec 2016 was reviewed. Patients with non-metastatic, node positive cancer were included for analysis. Any exposure to any of three therapy types (systemic, radiation, surgery) prior to recurrence.
2542 patients were included in the analysis. Over the time studied, the use of surgery has decreased (from 36% in pre 2009 to 16% in 2016) and initially, this decline was matched by a rise in the use of systemic therapy alone (37% to 51%). Since 2011 systemic therapy alone has reduced to 40%. In the same time period, there has been an increase in the use of radiation (with or without systemic therapy) to treat node positive prostate cancer (15% to 29%). The average increase in radiotherapy use across European countries was 11% (range Italy 2% - Spain 19%). A group of patients receiving combined surgery, radiation and systemic therapy comprise 11% of all cases, a figure that does not vary over time.
These data have demonstrated an international change in the management of node positive prostate cancer with decreasing use of surgery and increasing use of radiation. Although initially rising, the recent decline in the use of lone systemic therapy is likely to represent an increasing view that N1 prostate cancer is no longer a definitively palliative diagnosis.
Clinical trial identification
Legal entity responsible for the study
I. Wong: Honoraria: Janssen, Sanofi Aventis. H. Payne: Honoraria, advisory boards, travel expenses, consultant: AstraZeneca, Astellas, Janssen, Sanofi Aventis, Takeda, Amgen, Ipsen, Ferring, Sandoz and Novartis; Work support: UCLH/UCL Comprehensive Biomedical Research Centre. All other authors have declared no conflicts of interest.