LAUSR

We read with interest the article by Spratt and colleagues [1] recently published in European Urology. The authors analyzed patterns of abdominopelvic lymph node (LN) failure via radiographic LN mapping in a large series of prostate cancer (PC) patients treated with definitive doseescalated radiation therapy (RT) without pelvic LN RT. In their experience, radiographic failures were most frequently found above the L5/S1 landmark. Thus, for selected PC patients, the current pelvic LN RT recommendation could be revisited. The authors state that androgen deprivation therapy could prevent or minimize marginal and/or out-of-field recurrences. Moreover, Spratt et al [1] recommended revisiting of the current RT field recommendation for pelvic LNs (up to the superior border of the internal/external iliac vessels) because of inadequate RT coverage. Looking at their findings [1], a type of pelvic RT volume customization could be introduced in clinical practice. In fact, in the analysis by Spratt et al [1], PC patients with Gleason score 8 were at particular risk of dissemination to distant nodes. However, this PC category deserves accurate pre-RT staging to exclude distant dissemination [2]. Recent data support the value of molecular imaging in the therapeutic approach to high-risk PC. The reliability of new tracers (such as Cand F-choline and/or Galabeled prostate-specific membrane antigen [PSMA]) for PC has been investigated in several series [3]. While choline positron emission tomography (PET) is not indicated for routine local tumor staging, it seems to have better performance than conventional morphological imaging in LN staging and for all PC patients with suspected distant