How do you approach definitive radiation in a patient with an indwelling catheter due to obstruction from locally advanced prostate cancer?

This is a situation I encounter several times per year. The answer depends on whether or not I am being consulted strictly for palliation of the obstructive symptoms, or for curative intent therapy.

For strictly palliation in a man who has already been on ADT/Abi/Enza/Chemo etc with progression, when the goal is permanent de-catheterization, I have had good success with a 12 fraction regimen contouring all gross disease (GTV) and adding a 5mm margin to create a PTV (no CTV). I then prescribe 45 ...