How do you approach definitive radiation for prostate cancer in a patient with perineal urethrostomy?  

Long Answer: I probably treat about 2 patients a year with perineal urethrostomy, usually due to recurrent penile cancer post penectomy.  Keep in mind that when we treat prostate cancer, the penile urethra routinely receives ~78Gy EQD2 and with brachytherapy even higher biologically equivalent...