After definitive prostate RT, when do you prescribe ADT for local salvage (EBRT, HDR, LDR)?

For patients with localized recurrence after definitive radiotherapy, re-irradiation without ADT is a reasonable course of action and the one I usually favor. There are no current clinical trials that have been reported to demonstrate the benefit of ADT in this setting, but this practice is consistent with the recommendation of a recent consensus report from ESTRO/ACROP (Jereczek-Fossa et al., PMID 33965893). As such, many modern trials omit ADT as part of the salvage treatment protocol (e.g., Bergamin et al., PMID 32659332).

The recommendation to omit ADT is in part rationale-driven and related to the therapeutic objective. As noted in the question, short-course ADT has been used in several prior reports including RTOG 0526 (16%; Crook et ...