To evaluate the role of elective pelvic radiotherapy (WPRT) in the management of high-risk localized prostate cancer, focusing on patient selection, systemic treatment integration, and the complexities of treatment volume.
Key Findings:
Systemic intensification with ADT significantly improves metastasis-free survival (MFS) and overall survival (OS) in high-risk prostate cancer, underscoring the importance of systemic treatment.
WPRT does not show universal benefit and may increase gastrointestinal toxicity without clear survival advantages in certain patient groups, necessitating careful patient selection.
Careful patient selection based on nodal risk is crucial for deriving clinical benefits from WPRT, as supported by recent trials.
Interpretation:
The evidence suggests that WPRT should not be applied universally but rather selectively, particularly in patients with high nodal risk and when combined with effective systemic therapies, reflecting the complexities of treatment decisions.
Limitations:
The evidence base for WPRT is heterogeneous and varies by patient population, with many studies not isolating the impact of pelvic field size from systemic treatment effects.
Variability in patient characteristics and treatment protocols complicates the interpretation of WPRT's efficacy.
Conclusion:
WPRT may provide benefits in specific high-risk populations, especially when integrated with systemic therapies and advanced radiotherapy techniques, but should not be universally recommended without careful patient selection.
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