Salvage Whole Pelvic Radiation ± ADT

Allen,
- in the article you wrote "None had detected positive lymph nodes". How did they know that if they didn't do ePLND? Accurate staging of lymph node involvement could be valuable when selecting patients with expected benefit from whole pelvic radiation, or what do you think?
- That addition of androgen deprivation to SRT improves outcomes can't be controversial or..?

Gemlin-

(1) Some did have PLND, but not ePLND. The standard way of detecting cancerous LNs is via CT. These were largely unfavorable risk patients, so most would have had bone scan/CT. When I wrote none had detected positive lymph nodes, that does not mean that none had cancerous lymph nodes - in fact, from the outcomes - they actually did. It just means that if they had any prior to SRT, they were not detected. I don't believe that ePLND gives accurate staging of lymph node involvement. The evidence is otherwise.

We're still not very good at finding cancerous pelvic lymph nodes

As you will read, there are a couple of promising experiments for better detection of cancerous LNs intraoperatively, but they are still just experimental.

(2) There is no doubt that on the whole, and especially in high risk patients, adjuvant ADT improves SRT outcomes:

Combining Androgen Deprivation Therapy (ADT) and Salvage Radiation Therapy (SRT) improves outcomes


What remains controversial is determining in what situations it can reasonably be avoided; for example,can it be omitted when the biologically effective dose is high enough? when post-op PSA is low enough? when there were no adverse pathological findings? when the Gleason score was low enough?...