Jason Zhu, MD, a medical oncologist at Levine Cancer Institute, Atrium Health, discusses treatment strategies for patients with node-positive prostate cancer.

For patients with prostate cancer who are pathologic node positive, there is a select subset with a prostate-specific antigen of 0 following surgery for which observation is a reasonable treatment option, Zhu says. However, most patients will receive treatment with androgen deprivation therapy (ADT) plus radiation, he adds.

Moreover, for those who are clinically node positive, in addition to receiving ADT plus radiation, abiraterone can be utilized if the patient is fit but has aggressive disease. Otherwise, more fragile patients with a better pathology can be treated with ADT plus radiation, Zhu concludes.

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Jason Zhu, MD, discusses treatment strategies for patients with node-positive prostate cancer.

Dr. Zhu on Treatment Strategies for Node-Positive Prostate Cancer

Jason Zhu, MD, a medical oncologist at Levine Cancer Institute, Atrium Health, discusses the process of stratifying treatments for patients with node-positive prostate cancer.

For patients with clinical node-positive disease, it is important to consider the Gleason score from their original prostate biopsy, Zhu says. If the patient’s Gleason score is 6 or 7, androgen-deprivation therapy (ADT) plus radiation therapy can be utilized. However, if a patient is otherwise fit but with more aggressive disease and has a Gleason score of 8 or higher, abiraterone (Zytiga) can be added to that regimen, Zhu explains. This because the agent can add benefit by helping to prevent the development of metastases, Zhu notes.

In patients with a Gleason score that is higher than 8 who have many other medical comorbidities, such as uncontrolled atrial fibrillation or other cardiac toxicities, it is reasonable to administer ADT plus radiation, Zhu concludes.

Jason Zhu, MD, discusses the process of stratifying treatments for patients with node-positive prostate cancer.

Dr. Zhu on Stratifying Treatments in Node-Positive Prostate Cancer

Jason Zhu, MD, a medical oncologist at Levine Cancer Institute, Atrium Health, discusses the role of androgen deprivation therapy (ADT) in patients with pelvic node–positive prostate cancer.

For patients who have positive nodes following surgery, there is only 1 prospective, randomized, controlled trial that addresses the role of ADT; this research was led by Edward M. Messing, MD, of the University of Rochester Medical Center, and was published in the 

in 1999, according to Zhu. It was a small study that was conducted during a time when prostate-specific antigen (PSA) levels were not reliably checked before and after surgery, Zhu says.

In the study, a notable difference in overall survival (OS) was observed in patients who started ADT immediately vs those who delayed treatment; this treatment was often utilized when patients developed bone metastases, Zhu explains.

Practice has since changed, according to Zhu. ADT is frequently used much sooner in the treatment paradigm. Moreover, watching PSA doubling times and for biochemical recurrence is now common practice. The research revealed that starting ADT early provided an OS benefit, Zhu concludes.

Jason Zhu, MD, discusses the role of androgen deprivation therapy in patients with pelvic node–positive prostate cancer.

Jason Zhu, MD

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Dr. Zhu on Treatment Strategies for Node-Positive Prostate Cancer

Dr. Zhu on Stratifying Treatments in Node-Positive Prostate Cancer

Dr. Zhu on the Role of ADT in Pelvic Node–Positive Prostate Cancer