Jeff - thanks for all the information you have been providing on the questions I've been asking. You are very knowledgeable about the current research and treatment options. After reading the messages from you and others, it seems like ADT slows down cancer growth, but doesn't kill the cancer cells. And the only way to actually kill the cancer cells is through surgery or radiation. Also the cancer cells can mutate to make them ADT resistant. So it seems there is a high probability after ADT treatment that the cancer will eventually come back, and could become castration resistant.

I'm 64 and currently have a PSA of 0.2 after 4 years post RP, PSADT of 1 year, post RP clean margins and lymph nodes, and a negative PSMA/PET scan. I didn't have a decipher test done at the time of RP surgery. In a Dr. Kwon video, his recommendation was to wait until a scan positively identifies the cancer spot and then kill it with radiation. I'm hoping to get into Mayo soon to have a Choline 11 scan done. If that is also negative, does the current body of research support waiting until a scan identifies the cancer? Are there stats showing the effectiveness of waiting to identify the cancer and using radiation to kill it? For example, after this treatment plan, how many patients have their PSA increase again and have additional radiation treatments?

I believe I saw a statistic that salvage radiation to the prostate bed is about 30% effective at killing all remaining cancer cells with a PSA around 0.2 - is that correct? Are there stats showing how much more effective adding the ADT therapy on top of the radiation is?

Lots to consider and I appreciate your help and everyone else who is contributing to this forum! I will continue to share my treatment plan and effectiveness as well. A Huge Thank You To Everyone!!