Purpose: PATRON (NCT04557501) is a Phase III prospective randomized controlled trial assessing the impact of PSMA-PET (PET) guided intensified radiotherapy (RT) or surgery in patients with high-risk or recurrent prostate cancer. Here we report on the landscape of standard of care (SOC) radiotherapy practice across participating Canadian institutions, and the patterns of treatment intensification. Materials and Methods: Patients with either untreated high-risk prostate cancer (CAPRA score 6-10 or Stage cN1) or biochemically recurrent prostate cancer post-radical prostatectomy (RP) (PSA >0.1 ng/mL) were randomized 1:1 to either undergo conventional imaging (CV) or CV+PET imaging (18F-DCFPyl or PSMA 1007). All patients had a defined SOC radiotherapy plan as per local institutional standards based on CV. In the PET arm, protocol-specified radiation intensification was delivered to new PET-identified sites of disease. Results: Between January 6, 2021 and February 1, 2024, 796 patients from 19 participating institutions across Canada were randomized to the control SOC arm (n=400) and PSMA-PET arm (n=396). Of these, 730 were treated with RT (SOC n=367, PET n=363) and are the subject of this analysis. Median age was 71 years (interquartile range [IQR]: 66-75); 357 (49%) received definitive RT and 373 (51%) received salvage RT. Subjects with high-risk disease had a median CAPRA score of 7 (IQR: 6-8), median PSA of 18.1 (IQR: 11.1-31.4) and 37 (10%) were cN1. 99 (28%) had planned brachytherapy boost to the prostate and 48 (13%) had planned dominant intraprostatic lesion (DIL) boost (54% delivered with EBRT and 46% with brachytherapy). Patients undergoing salvage RT for biochemical failure post-RP had a median PSA of 0.30 (IQR: 0.19-0.53). Based on conventional imaging, 93% (n=332) and 68% (n=253) of the definitive and salvage RT cohorts, respectively, were intended to receive elective pelvic nodal irradiation. Median dose and dose-per-fraction for elective pelvic nodal irradiation was 45 Gy (range: 25-50.4) and 2 Gy/fraction (range: 1.5-5) respectively; with 27% treated at 1.8 Gy/fraction, 50% at 2 Gy/fraction, and 9% at 2.1 Gy/fraction. Median dose and dose-per-fraction for definitive radiation to prostate and seminal vesicles was 68 Gy (range: 35-80) and 2 Gy/fraction (range: 1.8-8) respectively; with 48% treated at 1.8-2.0 Gy/fraction, 19% at 2.7 Gy/fraction and 19% at 3 Gy/fraction. Guided by PSMA-PET, 160 (44%) of subjects had radiotherapy intensification: 105 (29%) and 32 (9%) with increased dose and volumes, respectively, at a planned site of treatment, 34 (9%) with addition of pelvic coverage, and 31 (9%) with oligometastasis directed therapy. Conclusions: Variability in standard of care radiotherapy was observed across participating sites, consistent with the pragmatic design that allowed institutional definitions of SOC. PSMA-PET led to modifications in radiation prescriptions in almost half of the subjects. We await further follow-up to report on the impact of radiotherapy intensification on patient outcomes.