Would you consider pelvic radiation in a patient with prostate cancer and myelofibrosis with mild cytopenias?  

I would avoid prophylactic RT in this scenario as the absolute benefit has to be weighed against the worsening of cytopenia.

It all depends on the clinical presentation. If the patient presents with node positive disease on PSMA scan and overall performance status is good to great, I would certainly make an effort to cover those nodes and make an effort to cover as much as possible elective lymph nodes and might consider ...

In general, if I was concerned about the toxicity of pelvic irradiation, I'd obtain a PSMA pet scan on the patient first, and if it was negative, would explain the pros and cons of treating the pelvis with the patient, but would recommend NOT treating the pelvic nodes to them, as if a node later pro...