What systemic therapy do you recommend for prostate cancer pelvic nodal recurrence on PSMA PET-CT after prostatectomy and salvage radiation?

If the LNs are not measurable on conventional imaging and can be covered in the radiation fields, then for now I treat as high risk salvage setting. Usually suggest 2 years ADT and radiation.

If the LNs cannot be covered in the radiation fields, or are measurable, then would also escalate AR-targeted treatments by adding enzalutamide, apalutamide, or abiraterone. The total duration that we shoot for is still about 2 years extrapolating from the high risk localized RADICALS-HD trial.

This is a data-free zone currently and a more accurate assessment of disease should not always change what we do until prospective data is available. The ECOG-Acrin 8191 INDICATE trial will help provide more prospective data in this setting. I would encourage ev...