When do you start ADT for a patient with a new diagnosis of node positive prostate cancer receiving radiation?

I would reverse the question order. For node-positive disease, I start ADT once staging imaging is complete. If logistically practical (as with high-risk localized), I often perform the simulation and start ADT at the same time, then start RT without a neoadjuvant period. Evidence for neoadjuvant AD...

We usually start upfront and start RT in a few months. This helps to see nodal response, can also sometimes help meet small bowel constraints with regression, and can also adjust the total dose if needed.

ASTRO 2022: Predictive Value of Ga68-PSMA PETCT-Based Response to Neoadjuvant Androgen Deprivat...

8 weeks prior to treatment planning

I have spent the last 25 years with a consistent philosophy about nodes and ADT. My basis: nodes are signposts of systemic disease that have yet to manifest. ADT is not curative but very effective at lowering PSA.

Now that we have Pylarify, we have a tool that should identify disease rather than ris...

My routine practice is to give ADT for at least 2-3 months prior to WPRT in patients with gross nodal disease with up to 3 years adjuvant therapy, and consideration of ARPI. It is demonstrated that 3-6 months ADT reduced nodal volume and that volume response is associated with improved disease contr...