<p><strong> </strong><strong>In patients with low- or intermediate-risk prostate cancer electing radiation therapy, clinicians should not electively radiate pelvic lymph nodes. <em>(Strong Recommendation; Evidence Level: Grade B)</em></strong></p>
Discussion
Discussion
<p>A prior trial (n=446) that compared whole pelvis (46 Gy with cone-down to prostate) to prostate-only (66 to 70 Gy) radiation therapy among low-, intermediate-, and high-risk patients with clinical stage T1b-T3 localized prostate cancer found no difference in PFS (adjusted HR 0.96, 95% CI 0.64 to 1.43) or OS between the treatment arms.<sup>265, 266</sup> Similarly, the RTOG 9413 trial, which contained intermediate-risk patients and utilized a 2 x 2 factorial design, demonstrated no significant difference in biochemical failure when comparing whole pelvic radiation therapy to prostate-only radiation.<sup>267-269</sup> As these are the only prospective trials with sub-groups of intermediate-risk patients, and no benefit was found with nodal radiation, the Panel recommends against the routine use of elective pelvic nodal irradiation for low- and intermediate-risk patients electing radiation therapy.</p>