Fig. 1.

A 74-year-old patient with biochemical recurrence (PSA 0.82 ng/ml; pT2aN0cM0; Gleason 6; iPSA 5.37 ng/ml) 8.4 months after radical prostatectomy and lymph node dissection. ⁶⁸Ga-PSMA PET/CT prior to salvage radiotherapy showed two PSMA-positive presacral (a, c) and retroperitoneal (b, d) LNMs. Salvage radiotherapy was extended to pelvic lymph nodes, including a dose escalation to the PSMA-positive lymph nodes. The patient was treated with IMRT (c, d IMRT plan). red PTV including pelvic lymph nodes (50.4 Gy), blue simultaneous and sequential boost (66 Gy) for iliac (d) and presacral (c) LNM. RT to prostate bed is not shown. The PSA level decreased to 0.02 ng/ml after SRT