Treating Primary Node-Positive Prostate Cancer: A Scoping Review of Available Treatment Options

SIMPLE SUMMARY: The best way to treat patients with prostate cancer who have positive lymph nodes is not clear. However, recent studies have suggested that intensifying treatment may help these patients and potentially cure their cancer. This review summarises the existing research that supports various treatment options investigated for these patients. For patients with positive lymph nodes that can be seen on pre-treatment imaging (clinically node-positive), the best treatment option is a combination of hormonal therapy and radiotherapy. Although intensifying the treatment seems promising, more research studies are needed to confirm its effectiveness. For patients with positive lymph nodes confirmed through pathology tests (pathologically node-positive), the treatment options depend on evaluating the risks based on factors such as the Gleason score, tumour stage, the presence of positive lymph nodes, and surgical margins. These patients should be closely monitored, and it is recommended to consider additional treatment with hormonal agents and/or radiotherapy. ABSTRACT: There is currently no consensus on the optimal treatment for patients with a primary diagnosis of clinically and pathologically node-positive (cN1M0 and pN1M0) hormone-sensitive prostate cancer (PCa). The treatment paradigm has shifted as research has shown that these patients could benefit from intensified treatment and are potentially curable. This scoping review provides an overview of available treatments for men with primary-diagnosed cN1M0 and pN1M0 PCa. A search was conducted on Medline for studies published between 2002 and 2022 that reported on treatment and outcomes among patients with cN1M0 and pN1M0 PCa. In total, twenty-seven eligible articles were included in this analysis: six randomised controlled trials, one systematic review, and twenty retrospective/observational studies. For cN1M0 PCa patients, the best-established treatment option is a combination of androgen deprivation therapy (ADT) and external beam radiotherapy (EBRT) applied to both the prostate and lymph nodes. Based on most recent studies, treatment intensification can be beneficial, but more randomised studies are needed. For pN1M0 PCa patients, adjuvant or early salvage treatments based on risk stratification determined by factors such as Gleason score, tumour stage, number of positive lymph nodes, and surgical margins appear to be the best-established treatment options. These treatments include close monitoring and adjuvant treatment with ADT and/or EBRT.