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

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...

I agree with @Dr. First Last 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 i...