Top Line: Clinical decision-making is easier when one size fits all: prostate only.
The Study: Now you can lean on another contemporary meta-analysis comparing definitive whole-pelvis versus prostate-only radiotherapy for clinically node-negative high-risk prostate cancer with concurrent androgen deprivation therapy. WPRT did not improve overall survival (HR 1.07, 95% CI 0.94–1.21). While pooled analyses suggested better biochemical/progression-free survival (HR 0.84) and metastasis-free survival (HR 0.92), these signals were driven largely by the single-center, PSMA-staged POP-RT trial and became null when this single trial was excluded. WPRT did modestly increase late grade 2+ GU/GI events as expected, though high-grade events remained uncommon with modern IMRT. TBL: Modern data does not strongly support routine elective pelvic nodal irradiation for unselected cN0 high-risk prostate cancer; the more interesting question is whether PSMA-PET staging paired with genomic classifiers can identify the very-high-risk patients in whom treating the pelvis meaningfully improves disease control. | Subiela, Clin Oncol 2026
The Study: Now you can lean on another contemporary meta-analysis comparing definitive whole-pelvis versus prostate-only radiotherapy for clinically node-negative high-risk prostate cancer with concurrent androgen deprivation therapy. WPRT did not improve overall survival (HR 1.07, 95% CI 0.94–1.21). While pooled analyses suggested better biochemical/progression-free survival (HR 0.84) and metastasis-free survival (HR 0.92), these signals were driven largely by the single-center, PSMA-staged POP-RT trial and became null when this single trial was excluded. WPRT did modestly increase late grade 2+ GU/GI events as expected, though high-grade events remained uncommon with modern IMRT. TBL: Modern data does not strongly support routine elective pelvic nodal irradiation for unselected cN0 high-risk prostate cancer; the more interesting question is whether PSMA-PET staging paired with genomic classifiers can identify the very-high-risk patients in whom treating the pelvis meaningfully improves disease control. | Subiela, Clin Oncol 2026