How do you approach post-prostatectomy pelvic lymph node only recurrence found on advanced imaging in a patient with a low PSA (~0.5)?

Topics: Radiation Oncology • Genitourinary Cancers

SBRT vs more comprehensive nodal RT with SIB to involved node? Would you include the prostate bed in your treatment volume? ADT duration? What other factors influence your approach (eg. specific type of advanced imaging, time since prostatectomy, findings at prostatectomy)?

Answer from: Radiation Oncologist at Community Practice

A lot will depend on the history of the patient. What were the initial parameters at the time of diagnosis (stage, initial PSA, Gleason score)? Were there positive margins at the time of surgery? How long of an interval before the time of recurrence? How was the "lymph node only" recurrence detected...

Comments

Radiation Oncologist at Cancer Treatment Center at Hazleton
In what situations would you consider biopsy of th...

Radiation Oncologist at Vanderbilt-Ingram Cancer Center
I would not make an attempt to biopsy a positive L...

Answer from: Radiation Oncologist at Community Practice

I agree with @Hoke Han about treating more comprehensively. I would give hormones for 6-9 months until the LN stops shrinking. After the node stops responding, I treat the prostate bed and LNs to 4680 cGy and boost the prostate bed to 6840 cGy. I will also SBRT boost the LN 650 cGy x 3 if it is...

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