I have encountered this situation more commonly in patients who have failed after radical prostatectomy and extensive pelvic lymph node dissection rather than in newly diagnosed patients. However, in the PSMA PET era, I believe we are seeing more patients with perirectal nodal involvement, so I have...

Curative intent radiation and androgen deprivation.

I believe this situation has two potential approaches: an aggressive approach and a minimalist approach. The aggressive approach would be 6-24 months of androgen deprivation with/without secondary agents (abiraterone, ...alutamide, taxanes) and comprehensive nodal radiation with dose escalation of t...

I would cover the entire mesorectum coplanar with and 2 cm superior and inferior to a PSMA-avid perirectal lymph node. I have seen perirectal lymph nodes not only posterior to the rectum but also lateral and anterior to the rectum on PSMA PET/CT, and I would feel exceedingly worried regarding risks ...