Prophylactic whole-pelvic nodal radiation therapy (WPRT) for high-risk and very high-risk prostate cancer provides improved outcomes compared with prostate-only radiotherapy (PORT), according to a recent study.

In a phase 3 study that included 224 patients randomly assigned to receive WPRT (110 patients) or PORT (114 patients), Vedang Murthy, MD, of Tata Memorial Hospital in Mumbai, India, and colleagues found that the 5-year biochemical failure-free survival rate — the study’s primary outcome — was significantly higher with WPRT compared with PORT (95% vs 81.2%).

In addition, compared with the PORT group, the WPRT patients had a significantly higher 5-year disease-free survival rate (89.5% vs 77.2%) and distant metastasis-free survival rate (95.9% vs 89.2%), Dr Murthy’s team reported online in the Journal of Clinical Oncology. Overall survival did not differ significantly between the treatment arms (92.5% vs 90.8% in the WPRT and PORT arms, respectively).

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Study inclusion criteria included at least a 20% risk of pelvic node involvement; clinical stage T1-T3a with Gleason 8-10 cancer and any PSA level or Gleason 7 cancer with a PSA level above 15 ng/mL or Gleason 6 cancer with a PSA level above 30 ng/mL; or clinical stage T3b-T4a with any Gleason score and any PSA level. All patients underwent image-guided, intensity-modulated radiotherapy and had received androgen deprivation therapy for at least 2 years.

The median follow-up duration was 68 months, during which 36 biochemical failures (29 in the PORT group and 7 in the WPRT group) and 24 deaths (13 in the PORT group and 11 in the WPRT group) occurred.

“Prophylactic pelvic irradiation using contemporary dose and technique of radiation along with long-term androgen deprivation therapy for high-risk and very high-risk prostate cancer should be routinely considered as standard treatment for these patients,” the authors concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Murthy V, Maitre P, Kannan S, et al. Prostate-only versus whole-pelvic radiation therapy in high-risk and very high-risk prostate cancer (POP-RT): Outcomes from phase III randomized controlled trial. Published online January 26, 2021. J Clin Oncol. doi:10.1200/JCO.20.03282