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

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 ...

I agree with @Dr. First Last'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%? >20%? That is a judge...

I am not aware of data suggesting Decipher predicts for lymph node involvement. Worse outcome, yes. LN involvement specifically, no.

GU-010 is evaluating whether Decipher can be used as a predictive marker as to the benefits of ADT, but until results are published, I would not use it as a predictive ...

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