What duration androgen deprivation do you recommend with salvage pelvic radiotherapy for pelvic node relapse after prostatectomy?

6 months ADT, 2 years ADT, 2 years ADT + abiraterone/prednisone seems reasonable depending on the circumstances. For example, early pelvic node recurrence for pT3b Gleason 4+5 would be a higher risk than a very late recurrence of pT2 Gleason 3+3.

Agree that there is some nuance in patient and tumor features, but ultimately this is cancer that has shown it can spread at least to lymph nodes so I generally aim for 2 years and at least discuss Abiraterone. If toxicity is high then can consider cutting short

Things that push me to shorter course...

While data is lacking in this situation, our default is 2 years of dual ADT.

Our rationale is that dual ADT was of benefit in STAMPEDE for gross nodes (granted not detected by PSMA), and ~2 years is standard for poor-risk localized disease, due in large part to the risk of eventual spread in that po...

At least 6 months, preferably 18 depending on tolerance

I use the gleason score of the resected cancer to determine the length of hormonal therapy. If we base our duration of hormonal ablation on the gleason score for primary treatment, why wouldn't we do the same for a nodal "recurrence", which is really untreated primary disease that was present at the...

One option may be to assess the androgen sensitivity of the recurrence by using Decipher, provided the area is amenable to biopsy. The result would offer the potential to tailor ADT to the patient.

To answer Dr.@Dr. First Last's question, the Enzalutamide trend might be due to an extrapolation from the EMBARK trial for high-risk biochemical recurrence. Many argue that a PEACE-V approach with 6 months ADT and Enzalutamide (or another ARPI) intensification might be the path forward for PET-PSMA ...

Depends on the scenario, the variations above are pretty standard. STORM and Oligopelvis use 6 m ADT monotherapy with RT. That's my minimum. Titrate up from there based on the scenario with max as 2 years ADT and abi. Many guys received salvage RT and maybe ADT and remember being castrated. They won...