When do you consider elective pelvic nodal irradiation for unfavorable intermediate risk prostate cancer?

Topics: Radiation Oncology • Genitourinary Cancers • General Radiation Oncology

Do you use decipher, or other genetic testing to determine whether you will include pelvic lymph nodes when you give definitive EBRT? Can you comment on using decipher to determine whether to give ADT and the length of ADT?

Answer from: Radiation Oncologist at Academic Institution

I consider elective pelvic nodal irradiation for patients classified as unfavorable intermediate risk by virtue of having Grade Group (GG) 3 disease, especially if they have high volume disease (50% or more of the cores are positive). These patients have a risk of lymph nodal involvement that is in ...

Comments

Radiation Oncologist at Staten Island Radiation Oncology
Thank you for the recommendations. One of the radi...

Radiation Oncologist at Lafayette Radiation Center
There is a good data that Decipher predicts for pe...

Answer from: Radiation Oncologist at Community Practice

I agree with @Mitchell S. Anscher's response. High-volume GG3 often will lead me to consider adding pelvic RT. I think the MSKCC pre-RP nomogram is also helpful- as it will give you an estimate of LN involvement. What is the “right” cut-off for adding pelvic RT, if the risk is >15%? &...

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Radiation Oncologist at Staten Island Radiation Oncology
I agree.

Answer from: Radiation Oncologist at Academic Institution

When the risk is 10% or higher based on the MSK and/or Briganti nomograms.

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Radiation Oncologist at Jacob E Locke MD PA
The added morbidity of treating pelvic nodes with ...

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