Do you boost involved mesorectal nodes in node positive prostate cancer?

This is an interesting question which has been at least partially addressed here: https://www.themednet.org/question/431. We utilize a similar paradigm of neoadjuvant ADT followed by pelvic RT of 46-50 Gy to elective nodal targets. We then try to boost the grossly involved nodes to a similar dose as...

For pelvic nodes, we would usually treat with a SIB dose of 55 to 57.5 Gy in 25 fractions (pelvis gets 45 Gy in 25 fractions). This is is equivalent to dose in upper 60s at 2 Gy per fraction based on what a/b value you used for calculation.

Regarding the nodal volumes, not dose, please see this PSMA PET patterns of failure analysis by Kilian Schiller: PMID 32451312.

The population is post op not intact, still food for thought.

I like to give obvious (+) LNs the same dose as I give the primary if no major DVH issues, certainly >=70 Gy at least (Sniper shooting single (+) LNs w CyberKnife to 40Gy/5 fx is satisfying too in some circumstances). Gross disease does not deserve to live, no matter where it resides...