How do you approach a solitary pelvic nodal recurrence following definitive radiation therapy to the prostate/SV?  

Briefly, I agree with @Mitchell S. Anscher and I occassionally offer treatment to solitary nodal disease, most commonly seen in the postprostatectomy, post-salvage RT setting. I'm generally not offering SBRT to nodal disease, since I think of the nodal basin needing RT (like 45 Gy with SIB to ...

This is a difficult situation, since the approach may vary depending on a number of factors, including the patient's overall health, the duration from treatment to recurrence, the size of the recurrence, rate of rise of the PSA and the original stage and grade of the tumor. If you're contemplating a...

I agree with @Mitchell S. Anscher's point about making sure there is no distant metastatic disease before pursing any further local therapy. If you have a confirmed isolated nodal recurrence, like @Howard M. Sandler I favor ADT then treatment to the treatable pelvic nodes electively to 45 Gy wi...

Anecdotally, we have had good experience with radiosurgery for nodal recurrence, measured as PSA control and also oligomets in general.   It's the whack-a-mole approach