Zaurito Paolo, Cosenza Andrea, Quarta Leonardo, Scilipoti Pietro, Longoni Mattia, Santangelo Alfonso, Viti Alessandro, Gettman Abigail, Barletta Francesco, Scuderi Simone, Cucchiara Vito, Stabile Armando, Montorsi Francesco, Briganti Alberto, Gandaglia Giorgio
Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy.
Vita-Salute San Raffaele University, 20132 Milan, Italy.
Cancers (Basel). 2025 Aug 27;17(17):2792. doi: 10.3390/cancers17172792.
: In approximately 10-15% of patients with prostate cancer (PCa), pathological lymph node metastases (pN1) are detected at radical prostatectomy (RP). The aim of this review is to describe the various treatment options for pN1 patients, with a focus on the most recent evidence reported in the literature. : Due to the lack of prospective studies, several retrospective analyses were conducted according to different types of treatment. Most common strategies are represented by observation plus early salvage radiotherapy (RT) in case of PSA rising, adjuvant androgen deprivation therapy (ADT) alone, or adjuvant RT with or without ADT. Patients with pN1 disease and favorable disease characteristics (lower T stage and ISUP ≤ 2 at RP, <3 metastatic nodes at pathology) have a similar overall mortality risk if observed with PSA testing and eventual use of early salvage RT compared to patients directly treated with adjuvant RT with or without ADT. While conflicting results in terms of survival benefit were reported for the use of adjuvant ADT only, several studies showed an overall survival benefit in patients with pN1 disease treated with adjuvant RT when high-risk features (such as an increasing number of positive nodes, ISUP > 3) were detected at RP. Lastly, few studies analyzed the rate of adverse events following adjuvant ADT or RT, leaving the issue of treatment-related side effects still open. : There is no clearly established standard of care for men with pN1 PCa, and disease characteristics should guide the choice of optimal post-operative management for these patients. Prospective data and clinical trials are clearly needed to define the most effective therapeutic strategy.
在大约10%至15%的前列腺癌（PCa）患者中，根治性前列腺切除术（RP）时可检测到病理性淋巴结转移（pN1）。本综述的目的是描述pN1患者的各种治疗选择，重点关注文献中报道的最新证据。由于缺乏前瞻性研究，根据不同治疗类型进行了多项回顾性分析。最常见的策略包括观察加PSA升高时的早期挽救性放疗（RT）、单独的辅助雄激素剥夺治疗（ADT）或联合或不联合ADT的辅助RT。与直接接受联合或不联合ADT的辅助RT治疗的患者相比，具有良好疾病特征（RP时T分期较低且ISUP≤2，病理检查转移淋巴结<3个）的pN1疾病患者通过PSA检测观察并最终使用早期挽救性RT，其总体死亡风险相似。虽然仅使用辅助ADT在生存获益方面的结果存在矛盾，但多项研究表明，RP时检测到高危特征（如阳性淋巴结数量增加、ISUP>3）的pN1疾病患者接受辅助RT治疗可获得总体生存获益。最后，很少有研究分析辅助ADT或RT后的不良事件发生率，治疗相关副作用问题仍未解决。对于pN1 PCa男性患者，尚无明确确立的护理标准，疾病特征应指导这些患者选择最佳的术后管理。显然需要前瞻性数据和临床试验来确定最有效的治疗策略。
