Treatment option for PC Recurrence

Hi,

I posted before. Now we know that radiation will be my husband’s option, but he is still making a decision on what kind. A brief history: diagnosed & get RALP at 47 yo(May 2021) with Gleason 8 & Stage 3Tb, undetectable PSA until 01/29/2026. PSMA scan on 02/04/2026. Confirmed recurrence in one lymph node on right external iliac on 02/13/2026.

We’ve met two radiation oncologists & have got a medical expert report via our health insurance. Here are the options:

1. 5 sessions of SBRT to only one affected lymph node. No ADT was recommended

2. 30 sessions of IMRT to the whole pelvic lymph nodes and drainage path. 1-3 years of ADT was recommended

3. 35 sessions of IMRT to the whole pelvic lymph nodes, drainage path, and prostate bed with the boosts to the affected lymph node. 1-3 years of ADT was recommended

In US, what is the standard of care for patients like my husband? We live in Germany but have use US Cigna (their international plan). They already informed me that for pre-authorization, they use American guidelines and t- based to make a decision. Thank you in advance.