Would you consider salvage radiation in a recurrent prostate cancer with a positive pelvic node and high inguinal node on PET/Axumin, but negative inguinal biopsy?

I would treat this patient as having oligometastatic disease to the nodes, similar to the more common scenario of finding 1-3 para-aortic nodes beyond a typical pelvic XRT field.

Assuming no prior radiation to these sites, I would try a VMAT plan as long as skin constraints are met for the inguinal s...

I would have a discussion with the radiologist. Not all that lights up on Axumin is prostate cancer. It can depend on CT characteristics. If it was borderline on Axumin and you have a negative biopsy, I would leave him be.

If it's high inguinal and could easily be covered without additional toxicity...