Would you compromise target coverage to meet OAR constraints for prostate radiation?

Median lobes can sometimes be challenging. There are a few options in this scenario.

First, and most simply, ensure your bladder is comfortably full for simulation. Most IMRT bladder constraints are volumetric, so larger bladder sizes make meeting constraints easier.

Second, if the median lobe is c...

Generally, no, I'd treat as planned. I treat at 725 cGy/fx for 5 fx. The bladder constraints I use are D10% <18.1 Gy and D0.03cc <38.1 Gy. It's not unusual to not meet the 10% criteria in patients with large and/or irregular prostates. I have not, as yet, seen bladder damage or late effect dysfuncti...