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Purpose: In patients with prostate cancer, a little known aspect in the post-operative setting is whether irradiating the lymph node chains instead of the prostate bed alone can confer an additional benefit in terms of disease recurrence. Purpose of our study was to demonstrate an improvement of biochemical control by post-operative nodal irradiation respect to prostate-only irradiation in patients with prostate cancer undergoing radical prostatectomy.

Material and Methods: We evaluated 404 patients with prostate cancer treated with adjuvant or salvage RT at Radiotherapy Unit of Pisa University Hospital from January 2011 to December 2011. All patients were treated using VMAT radiotherapy. ADT was administered to patients with high-risk prostate cancer in accordance with EAU guidelines. We studied biochemical progression free survival for each category of risk according to the NCCN classification. We did multivariate analysis of Progression Free Survival factors risk by step-wise method.

Results: Evaluating all patients with a median follow-up of 62 months, we did not found statistically significant advantage (p=0,77) by nodal radiotherapy; however, in the analysis of sub categories, we found a trend toward a significant advantage in prophylactic nodal irradiation in 140 patients with low and intermediate risk class (p=0,056).

Conclusion: Our study highlights how the whole pelvic nodal prophylactic radiation therapy does not offer an additional benefit in all patients, but only in selected patients with low-intermediate prostate cancer. Larger and prospective studies are needed to confirm our results.