While it may not be as easy to defend blanket treatment of elective nodes in all high risk patients, some patients may still merit nodal coverage. Plus, those with nodal disease benefit from elective nodal coverage. In this trial, fifty men with unfavorable intermediate to very high-risk prostate cancer (20% N1) were treated with PSMA PET/MRI-guided 5-fraction SABR delivering 25 Gy to the pelvis, 35 Gy to the prostate and PET-positive nodes, and up to 50 Gy to the dominant intraprostatic lesion. OAR constraints took precedence as the median delivered boost dose was 44.1 Gy. All patients also received 6–18 months of ADT. At a median follow-up of 3 years, late grade 2 GU events occurred in 10% of patients, with no grade ≥3 GU events. One patient had a grade 4 rectal wall defect requiring colostomy, which developed shortly after argon plasma coagulation for proctitis. There were no isolated local failures. | Alayed, Radiother Oncol
