Well, your PSA data may indicate BCR...too soon, depends...!

First question is, what are your doctors recommending, is the IMRT to the prostate bed only or do they plan in extending the treatment field to the pelvic lymph nodes (the latter being a significant decision)? How long are they saying saying will you be on ADT, when will you start it, simultaneously, shortly before you start IMRT, what ADT agent do they plan on you using, will they add an ARI, if so, why, when...

Second question is, do you want to wait until your PSA rises to a level where you and your medical team are comfortable that one of the PSMA scans could reasonably locate the recurrence and thus inform your decision? Would waiting for that change your treatment decision, would it entail any risk to the outcome...?

How aggressive do you want to be in your treatment. Including the PLNs is one example, Adding an ARI is another, do you add it from the start or wait to see if the ADT drops your PSA to undetectable in the first three months or so, if not, add the ARI, A third is how long you want to be on ADT, 6, 12, 18, 24, 36 months..., want to be super aggressive, chemotherapy?

Waiting until your PSa reaches say .5-1 which is where the statistical probability of locating a recurrence increases greatly may also give you sufficient PSA results to calculate PSADT and PSAV, more clinical data informing your treatment decision.

These are questions and discussions you may want to have with your medical team before pulling the trigger and treating.

If your PCa has escaped the prostate and is advanced, generally, the medical community says it is not curative though that may be based on past therapies. With newer drugs, better imaging, improved radiation planning software and delivery hardware, maybe. More likely, managing with the outcomes of treatment being control and progression free survival vice say overall survival though that too can be allowing an end from something else. My medical team knows their mission is "something else", so far, they are successful over the ten years.

Kevin