Current State of Adjuvant Hormone Therapy in Prostate Cancer and in the Management of Pelvic Nodal Recurrence: A Narrative Review
4 affiliations
- 1Radiation Oncology Unit, IRCCS CROB, 85028 Rionero in Vulture, PZ, Italy
- 2Physic Unit, IRCCS CROB, 85028 Rionero in Vulture, PZ, Italy
- 3Pharmacy Unit, IRCCS CROB, 85028 Rionero in Vulture, PZ, Italy
- 4Nuclear Medicine Unit, IRCCS CROB, 85028 Rionero in Vulture, PZ, Italy
Abstract
In post-prostatectomy prostate cancer, combining androgen deprivation therapy (ADT) with salvage radiotherapy (SRT) significantly improves clinical outcomes, though the absolute benefit varies based on baseline PSA, pathological risk, and treatment design. This review synthesizes findings from key randomized trials and contemporary meta-analyses—including RTOG 9601, SPPORT, GETUG-AFU 16, GETUG-AFU 22, and RADICALS-HD—evaluating the integration and duration of ADT with postoperative irradiation. While systemic therapy consistently enhances biochemical and clinical progression-free survival, a universal overall survival benefit remains uncertain or limited to high-risk cohorts with elevated pre-treatment PSA values. Concurrently, data from the prospective phase II OLIGOPELVIS (GETUG P07) and PEACE V-STORM trials are redefining the standard of care for pelvic nodal oligorecurrent disease detected via next-generation imaging (NGI). Transitioning away from exclusive lifelong ADT or isolated focal metastasis-directed therapy, emerging evidence strongly supports a multimodal paradigm: combining prostate bed RT, whole-pelvis elective nodal irradiation, and a high-dose boost to PET-positive nodes, complemented by a short course of systemic therapy. Ultimately, this narrative review provides clinicians with evidence-based guidance on integrating ADT to maximize regional disease control and delay systemic progression, while successfully sparing the majority of patients from the toxicities of continuous ADT.
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BibTeX
@article{dandrea2026current,
title = {{Current State of Adjuvant Hormone Therapy in Prostate Cancer and in the Management of Pelvic Nodal Recurrence: A Narrative Review}},
author = {Barbara D’Andrea and Antonietta Montagna and Ilaria Benevento and Luciana Rago and Vito Metallo and Gerardo Morano and Melissa Romaniello and Fortunata Possidente and Vincenzo De Fina and Antonella Bianculli and Rosa Maria Carmela Lerose and Carmela Mazzoccoli and Donatella Telesca and Giovanni Storto and Rosj Gallicchio and Grazia Lazzari},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208047},
url = {https://www.mdpi.com/2077-0383/15/20/8047},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Current State of Adjuvant Hormone Therapy in Prostate Cancer and in the Management of Pelvic Nodal Recurrence: A Narrative Review
AU - Barbara D’Andrea
AU - Antonietta Montagna
AU - Ilaria Benevento
AU - Luciana Rago
AU - Vito Metallo
AU - Gerardo Morano
AU - Melissa Romaniello
AU - Fortunata Possidente
AU - Vincenzo De Fina
AU - Antonella Bianculli
AU - Rosa Maria Carmela Lerose
AU - Carmela Mazzoccoli
AU - Donatella Telesca
AU - Giovanni Storto
AU - Rosj Gallicchio
AU - Grazia Lazzari
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208047
UR - https://www.mdpi.com/2077-0383/15/20/8047
AB - In post-prostatectomy prostate cancer, combining androgen deprivation therapy (ADT) with salvage radiotherapy (SRT) significantly improves clinical outcomes, though the absolute benefit varies based on baseline PSA, pathological risk, and treatment design. This review synthesizes findings from key randomized trials and contemporary meta-analyses—including RTOG 9601, SPPORT, GETUG-AFU 16, GETUG-AFU 22, and RADICALS-HD—evaluating the integration and duration of ADT with postoperative irradiation. While systemic therapy consistently enhances biochemical and clinical progression-free survival, a universal overall survival benefit remains uncertain or limited to high-risk cohorts with elevated pre-treatment PSA values. Concurrently, data from the prospective phase II OLIGOPELVIS (GETUG P07) and PEACE V-STORM trials are redefining the standard of care for pelvic nodal oligorecurrent disease detected via next-generation imaging (NGI). Transitioning away from exclusive lifelong ADT or isolated focal metastasis-directed therapy, emerging evidence strongly supports a multimodal paradigm: combining prostate bed RT, whole-pelvis elective nodal irradiation, and a high-dose boost to PET-positive nodes, complemented by a short course of systemic therapy. Ultimately, this narrative review provides clinicians with evidence-based guidance on integrating ADT to maximize regional disease control and delay systemic progression, while successfully sparing the majority of patients from the toxicities of continuous ADT.
SN - 2077-0383
ER -