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Radiation therapy delivered post-prostatectomy can provide durable disease-free clinical outcomes. There remains debate as to whether the radiation should be applied to patients with high risk features post-surgery or deferred until there is biomarker evidence of clinical recurrence. Prior to the development of advanced-technology metabolic and anatomic imaging, the radiation therapy treatment fields were applied based on historical models of patterns of failure including the former capsule region, undersurface of the bladder, and the bladder urethral anastomosis. Although outcomes of therapy were good, the choice of the target was not image directed. Modern imaging has provided an advantage for targeting as radiation oncologists can be more secure of high-risk areas and in turn titrate dose to regions deemed of intermediate and low risk. In this paper we describe strategies for application of modern axumin imaging for patient care with radiation therapy post prostatectomy.
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