Current State of Adjuvant Hormone Therapy in Prostate Cancer and in the Management of Pelvic Nodal Recurrence: A Narrative Review

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 trials OLIGOPELVIS (GETUG P07) and PEACE V - STORM 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. This narrative review provides readers with effective indication to use adjuvant HT according recent literature evidences to maximizes regional disease control and delays systemic progression, while successfully sparing the majority of patients from the toxicities of continuous androgen deprivation.