Randomized Trials and the Goldilocks Problem (European Urology)

Providing therapy with the right level of aggressiveness for the right patient is an overarching principle of cancer treatment. Randomized clinical trials have been part of the backbone of research to provide high-quality evidence to inform treatment decisions. For prostate cancer patients without known nodal metastasis, whether elective radiation therapy (RT) to the pelvic nodes is warranted is an important clinical question. Elective irradiation of the pelvis causes bowel toxicity, although at relatively modest rates with modern technologies including intensity-modulated RT and image guidance [1].