13 Nodal recurrent prostate cancer

Question 1

Nodal recurrent prostate cancer? Do we treat the node just with EBRT or do we do elective nodal treatment?

Answer 1

A multi-institutional, retrospective analysis of 506 pts suggest that we should be doing ENRT.
506 (SBRT: 309, ENRT: 197) patients with hormone-sensitive nodal oligorecurrent PC (five or fewer lymph nodes (LNs; N1/M1a). ENRT reduced the number of nodal recurrences as compared with SBRT, however at higher GI toxicity. The findings hypothesize that ENRT should be preferred to SBRT in the treatment of nodal oligorecurrences. Greater benefit with low nodal burden.

Question 2

Approach to nodal recurrent PCa

Answer 2

ENRT and with higher dose delivered to the areas of gross disease and prostate fossa (if no adjuvant RT). Empty bladder if prior fossa radiation. Deliver RT with ADT.
Generally 50.4 Gy in 28 Fx with SIB of 61.6 Gy