What is your radiation approach/details for regionally involved prostate cancer (N1)?

For intact cases, I usually attempt to deliver a single-phase plan with multiple dose levels in 28 fractions as detailed below:

Elective Pelvic LN volume (CTVn1): 50.4 Gy/28 fx. In cases of N1 disease, I would usually include the common iliacs. When the GTVn is near the cranial field edge, I usually ...

Agree with Dr. @Dr. First Last regarding the overall approach.

• Ideally, fuse a pre-ADT PET.
• Some period of neoadjuvant ADT. I'm not particularly stringent on the timing of RT initiation.
• Treat elective nodes up to the aorta bifurcation (i.e., include common iliac).
  • If the high common iliac node is...

Another advantage of neoadjuvant ADT is reduced GTV nodal volume, which makes it easier to achieve dosimetric constraints for boost dose and also the potential to reduce total boost dose to nodes that have normalized in size and appearance.

I agree with Drs.@Dr. First Last and @Dr. First Last on the radiotherapy details above.

Concerning ADT, I was wondering what the rationale is for systematically recommending neoadjuvant ADT.

Since we are treating with radical RT, I would rather recommend a similar approach as for very high risk dise...