Background
toxicity, prostate, N1M0, tumour, primary node-positive prostate cancer, prostate cancer
SYSTEMIC DISEASE, METASTASIS, LYMPH NODE METASTASES, DISEASE STILL, DISEASE, PROSTATE, TUMOUR, METASTASES, PROSTATE CANCER
In the past, prostate cancer patients with nodal metastases were not considered for curative treatment, based on the assumption that cure was neither feasible nor beneficial, based on the hypothesis that patients with lymph node metastases are affected by a systemic disease. With the introduction of molecular imaging targeting the prostate-specific membrane antigen (PSMA), the number of patients diagnosed with primary node-positive prostate cancer without distant metastasis (staged N1M0) is increasing as PSMA PET/CT allows better detection of small nodal metastases and at the same time better exclusion of distant metastases (including nodal metastases in non-standard locations) with a high positive predictive value [Despite the improvements provided by aggressive multimodal locoregional EBRT with systemic long-term ADT, patients with N1M0 disease still have a suboptimal prognosis. Although the majority of patients have a long survival, curation is not always achieved and the 5-year (biochemical) failure rate is currently reported at 29–53% [Unfortunately, options are limited. Dose escalation of EBRT for prostate cancer is difficult due to toxicity in regional organs at risk. There are several new pharmaceutical options to intensify systemic ADT, but this has not been proven effective for primary treatment of N1M0 patients and it would likely increase long-term toxicity. The same is true for adding systemic chemotherapy, which was demonstrated to be not beneficial for low-volume metastatic patients and would also contribute to unwanted toxicity [Radionuclide therapy using PSMA-ligand labelled with [Example of response of [In case of high tracer accumulation in the primary tumour and nodal metastases, a similarly high dose delivery and good anti-tumour effect could be expected in the curative setting. In combination with EBRT and ADT, the concurrent and synergistic dose delivery could enhance EBRT to better control macroscopic tumour in the prostate and detected involved nodes, and it could also treat undetected microscopic disease locations inside and outside EBRT fields.This study aims to explore the tolerability of the combination of standard EBRT and ADT complemented with a single administration of [