Who this is for
Lymph node-positive prostate cancer means prostate cancer has reached nearby lymph nodes, but this does not always mean the cancer has spread widely.
This article is for men who have been told their prostate cancer has reached a nearby pelvic lymph node but whose PSMA PET scan shows no evidence of spread elsewhere in the body.
It may also be helpful for patients seeking a prostate cancer second opinion in Melbourne, Australia, Sri Lanka, Maldives, Indonesia or the Philippines.
Clinical observation
A 65-year-old man is told that his prostate cancer has reached a nearby pelvic lymph node.
Naturally, he is frightened.
His first question is simple:
“Does this mean my cancer has spread everywhere?”
This is one of the most common misunderstandings in prostate cancer.
A positive pelvic lymph node does not automatically mean widespread metastatic disease.
It tells us the cancer is higher risk.
However, it does not necessarily mean the opportunity for long-term control, or even cure, has been lost.
This distinction has become increasingly important because newer treatments may help some patients when used earlier rather than waiting until the cancer spreads elsewhere in the body.
Lymph node-positive prostate cancer: What did STAMPEDE test?
The STAMPEDE study included 1,974 men with newly diagnosed high-risk prostate cancer that had not spread to distant organs.
About 39% of patients had cancer involving nearby lymph nodes.
Most patients received or were planned for radiotherapy.
The study compared:
- Standard hormone therapy, also called androgen deprivation therapy or ADT
- ADT plus 2 years of abiraterone and prednisolone
Researchers recruited patients from centres in the United Kingdom and Switzerland.
The study did not include centres from Australia or the United States.
Key results
- The risk of future metastatic spread was lower.
Men who received abiraterone were 47% less likely to develop metastatic disease or die during the study period. - More men remained free from metastatic spread after 6 years.
After 6 years, approximately 82% of men receiving abiraterone remained free from metastatic spread, compared with 69% receiving standard treatment. - Overall survival was better.
Men receiving abiraterone were approximately 40% less likely to die during the study period. - The benefit included men with lymph node-positive disease.
The improvement was not limited to one small group of patients. It was also relevant to men whose prostate cancer had reached nearby pelvic lymph nodes.
There is one important detail patients should understand.
The STAMPEDE study was based on conventional imaging, such as CT and bone scans.
Today, many patients in Australia have PSMA PET scans, which can detect prostate cancer more accurately than older imaging tests.
This means doctors need to carefully interpret STAMPEDE results in the modern PSMA PET era.
In simple terms, the treatment evidence is very strong, but applying it to each patient still requires careful specialist judgement.
What this means for you
The reason this study matters is simple.
For many years, we treated most high-risk prostate cancers in a broadly similar way.
Some patients may benefit from treating the cancer more intensively at the beginning, before it has the opportunity to spread elsewhere.
For patients with locally advanced or lymph node-positive prostate cancer, but no evidence of distant spread on PSMA PET imaging, adding abiraterone to standard hormone therapy appears to reduce the chance of future metastatic disease and improve survival.
However, this does not mean every patient should receive abiraterone.
Age, heart health, blood pressure, diabetes, liver function, treatment tolerance and personal preferences all need to be considered carefully.
Current access in Australia
Access to abiraterone in Australia depends on the prostate cancer setting and current PBS criteria.
Although the STAMPEDE evidence supporting abiraterone in high-risk non-metastatic prostate cancer is strong, PBS funding does not always match every evidence-based indication.
For example, abiraterone acetate and prednisolone was listed on the PBS for metastatic castration-resistant prostate cancer from February 2026, but this is different from the non-metastatic high-risk setting discussed in this article.
As a result, treatment recommendations and treatment access are not always the same thing.
Depending on the situation, access may sometimes occur through private prescription, clinical trials, compassionate access programs or other pathways.
For patients seeking prostate cancer treatment in Melbourne, Australia, or second opinions from Sri Lanka, Maldives, Indonesia or the Philippines, this has become an important discussion in modern prostate cancer care.
Overall, lymph node-positive prostate cancer is an area where treatment decisions are becoming more personalised, especially with modern imaging and earlier treatment intensification.
Key takeaways
- A positive pelvic lymph node does not always mean widespread prostate cancer
Some men are still treated with long-term control, or even cure, as the goal. - Earlier treatment intensification may help selected men
In STAMPEDE, adding abiraterone to ADT reduced the risk of future metastatic spread and improved overall survival. - PSMA PET has made treatment decisions more precise
Modern imaging can show more detail than older CT and bone scans, but this also means trial results must be interpreted carefully. - Access and evidence are not always the same
A treatment may be supported by strong evidence but still have complex funding or access pathways in Australia.
Key evidence
- Attard G, Murphy L, Clarke NW, et al. Abiraterone acetate and prednisolone with or without enzalutamide for high-risk non-metastatic prostate cancer: a meta-analysis of primary results from two randomised controlled phase 3 trials of the STAMPEDE platform protocol. 2022;399(10323):447-460. doi:10.1016/S0140-6736(21)02437-5
- Hofman MS, Lawrentschuk N, Francis RJ, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy: a prospective, randomised, multicentre study. 2020;395(10231):1208-1216. doi:10.1016/S0140-6736(20)30314-7
- European Association of Urology. Prostate cancer: treatment. EAU Guidelines. Accessed June 12, 2026. https://uroweb.org/guidelines/prostate-cancer/chapter/treatment
Frequently asked questions (FAQs)
- Does a positive lymph node mean my cancer is incurable?
No. Many men with cancer involving nearby pelvic lymph nodes are still treated with long-term disease control and potential cure as the goal.
- If my PSMA PET scan is negative elsewhere, is that good news?
Yes. This means there is currently no evidence of distant metastatic disease, which is exactly the group that appears most likely to benefit from earlier treatment intensification.
- Why isn’t abiraterone routinely PBS funded for this?
PBS decisions depend on both clinical benefit and cost-effectiveness assessments. Clinical evidence often evolves faster than reimbursement systems.
- Can I still access abiraterone in Australia?
In selected circumstances, access may be possible through private prescription, clinical trials, compassionate access programs, or other pathways. This should be discussed individually with your treating oncologist.
Dr Dilanka De Silva
MBBS, MRCP(UK), MRCP(UK SCE Oncology), FRACP, PhD
Medical Oncologist & Cancer Genetics Physician
Memorial Sloan Kettering Cancer Center Fellow (New York, USA)