When do you consider lymphadenectomy vs pelvic lymph node RT in a lymph node recurrence after prior prostatectomy or prostate-only RT?

I typically recommend a modified GETUG P07 (OLIGOPELVIS) treatment paradigm in this setting because I believe it has a favorable toxicity and short term treatment efficacy as well as the best evidence basis at this time. This regimen consists of a fractionated, extended pelvic nodal field with conco...

This is subject to ongoing study (surgery SBRT vs. regional RT)

De Bruycker et al., PMID 32398040

We usually favor regional nodal RT with SIB boost to node unless there are contraindications.

If he has had a prostatectomy, would do salvage to prostate fossa + LNs with SIB to gross LN.

If he had prostate RT with no suspicion for in-prostate recurrence, would salvage LN basins with SIB to gross LN.

I know some are doing SBRT alone in regionally recurrent patients, but retrospective data fav...