Regional lymph node coverage is commonly recommended in radiation therapy for prostate cancer in both the intact and postoperative settings.1-3 The goal of pelvic nodal radiation is to sterilize the macroscopic and microscopic regional dissemination of cancer while sparing the surrounding normal tissues. Historically, the pelvic lymph nodes considered most at risk were the internal, external, obturator, and presacral nodes. Peri-rectal lymph nodes were considered low risk. These are not included in lymph node dissection during prostatectomy and have not routinely been included in modern radiation therapy treatment planning.
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