How would you manage an aortocaval nodal recurrence of prostate cancer in a patient who previously received salvage radiation to the fossa and pelvic nodes?

One can do either with some rationale but more data on SBRT in this setting with the goal to either delay initiation of ADT (STOMP and ORIOLE) or maintain eugonadic status (EXTEND).

These trials for OM did include patients with pa nodal recurrence.

Salvage the electives with SIB to gross. Whatever dose/fx you prefer. Attempt to maintain eugonadal, a very relevant endpoint. (MDT)

Agree, no clear standard. If single lymph node and relatively low PSA then might favor SBRT vs elective nodal coverage for multiple radiographically involved/macroscopic nodes.

Treat a large volume with an integrated boost combined with ADT. If possible, assess the prostatectomy with Decipher to understand the radiation sensitivity and androgen response to help determine optimal ADT. Aggressive tumors may benefit from treatment intensification and prolonged duration of ADT...