Forgot to mention that I have a high decipher score

That's a great question to ask your doctors and research. It probably also depends on your overall health. There are many treatments (Dr. Walsh's book talks about options in Ch. 5), but my understanding is that a 2nd round of radiation if the 1st fails is not very recommended. Radiation isn't kind to your surrounding parts (bladder, colon). Seeds may be an option if IRMT fails - Research it, outline all the questions you can, and ask a specialist (dr.). I typed out all of my questions and interviewed doctors with them, which I found helpful. Be wary of practitioners trying hard to sell their services a little too hard. I don't think there is usually one "right" answer. You need to find which treatment is the best match for you and your circumstances.

If IMRT fails and PCa comes back in the same area your options as I understand them would include combination first generation ADT (Lupron, Erleada, or ORGOVYX) and second generation ADT, (Abiraterone or enzalutamide) along with some form of chemotherapy. Depending on the genomic profile of your pathology you might be eligible for something like T cell therapy.

I can’t tell you how much I regret having radiation as my primary therapy in 2020. I wanted to avoid ED and any possibly of incontinence at all costs. Here in 2024 I recognize that the cost was recurrence with Stage 3 PCa with lymph node involvement.

Whatever you choose I hope your outcome is better than mine!