Words of Wisdom Re: The Impact of Definitive Local Therapy for Lymph Node–positive Prostate Cancer: A Population-based Study

The role of local treatment (with surgery or radiation [RT]) for patients with lymph node–positive M0 prostate cancer (PCa) is controversial because there are no reports from randomised clinical trials on this topic. In their study, Rusthoven et al extracted data on PCa patients from the SEER database. T1–4, N1, M0 patients diagnosed from 1995 to 2005 were analysed in two separate cohorts (796 clinical [cN+] and 2991 patho-logical [pN+] patients) to evaluate the impact on overall survival (OS) and prostate cancer–specific survival (PCSS) of definitive local treatment (RT alone for the cN+ group and RP RT for the pN+ group) compared to no local treatment (NLT). For both groups, local therapy was highly significant for both OS and PCSS compared to NLT in multivariate analysis ac-counting for age, race, marital status, tumour registry location, T stage, year of diagnosis, number of lymph nodes removed