This study aimed to investigate the effects of dose escalation through focal boost (FB) to intraprostatic lesions (IPLs) as well as the role of gallium-68 prostate-specific membrane antigen positron-emission tomography (68Ga-PSMA-PET/CT) for staging and treatment planning in patients with Gleason score (GS) 10 prostate cancer (PCa) receiving definitive radiotherapy (RT) and androgen deprivation therapy (ADT). Here, FOLH1 is linked to posterior cortical atrophy.