"The T-Stage may be a very important factor in the Partin Tables, but we only have cT-status before definitive radiotherapy not pT-status."
The Partin tables actually use the CLINICAL stage, not the PATHOLOGIC stage, to predict the risk of ECE, SVI and Pelvic LN involvement. That is why they are such a valuable resource for radiation oncologists, because they quantify the relationship between clinical and pathologic variables.
I am aware that the Partin tables use the cT-Status.
The problem is that the data, the Partin tables are based on, are quite old and most cT-estimations were done without MRI or modern techniques. This is the point I was trying to make, I am sorry you misunderstood me.
"One could indeed speculate that the impact shown by previous studies through WPRT was because a lot more patients were actually curatively treated for then undiscovered macroscopic lymph node metastasis through WPRT"
That is the whole point, previous studies have shown NO impact of WPRT, even in a group of patients with higher risk of having cN1 disease due to older staging modalities. In the setting of improved pelvic LN staging, one could argue that the rationale for routine use of WPRT in cN0 patients is even less sound...
You are not getting what I am trying to say.
Some people often look back at older RTOG trials that tested hormone therapy duration and argue that WPRT is important because those older trials were performed with WPRT, so this should be standard of care.
Some other people demonstrate new data with prostate only radiotherapy and say that the control rates with prostate only radiotherapy are the same with WPRT, so we could ommit WPRT.
My point is:
One could speculate that the following two mechanisms led to same control rates in older studies with WPRT and in modern studies without WPRT:
1. The older studies treated patients with cN1 (mistakenly) with WPRT , because imaging was not sophisticated and did not recognize cN1. This lowered the progression free survival in the entire population.
2. In the newer studies patients with cN1 were identified more often than in the provious trials and eliminated from the studies. Patients with cN0 were then treated with prostate only RT, however some of them did harbor micrometastatic disease in the lymph nodes. Therefore some of these patients later recurred regionally. This lowered again the progression free survival in the entire population.
There two effects brought the progression free survival rates of WPRT and prostate only RT close eo each other and led to the argument, that one can ommit WPRT. What people did not think about was, that the patients included in the studies 15 years ago were staged in a different way than patients are staged nowadays.
Therefore one can speculate that WPRT is still useful in patients with high risk of harboring micrometastasis and staged correctly to rule out cN1.
Do you understand what I mean? I am sorry, but I am not a native speaker.