Thanks Phil. I will bring this all up at my Oncologist meeting. I'm sorry, what does SE's in your reply stand for?

"If you had radiation first (which many men have), you’d be facing a lot of ADT for a much longer time, possible doublet therapy, and risky salvage surgery as a last resort."

Thanks for sharing that, Phil. Just to add to it, if cancer recurs after a prostatectomy or a large dose of radiation to the prostate, it's usually because some cancer cells had already escaped the prostate but had not yet formed tumours big enough to show up on scans. Unlike surgery, radiation can incapacitate cancer cells in the area immediately outside the prostate because the radiation continues to spread for a couple of weeks after treatment, but the downside is occasional mild radiation cystitis or proctitis caused by the same spread; regardless *both* will miss cells that have managed to move further away. If they form significant tumours somewhere else in your body, like the bones, lymph nodes, or more rarely lungs, then you may end up needing doublet therapy or triplet therapy (depending on how many metastases there are) and long-term ADT regardless of whether you started with radiation or surgery, unfortunately.

An unfortunate human-factors problem with both is surgeons or radiation oncologists who say "We got it all!" and give false reassurance to patients, when, frankly (as Phil suggests), there's no way to know with current medical science. A more honest statement after either radiation or surgery would be "It's likely your cancer was localised and low risk, so you may not see any recurrence for many years, if at all, but we'll keep a close eye on it just to be safe."

Well, more bad news for me as my PSMA pet scan results came in. My bcr .24 3 years after prostatectomy resulted in this. Images of the prostate demonstrate a focus of increased uptake to the right midline in the inferior aspect of the prostate with a maximum SUV of 4.1 suspicious for malignant disease. Musculoskeletal: There is a prominent focus of increased uptake involving the left first rib with a maximum SUV of 6.3 for which metastatic disease cannot be excluded. This is associated with sclerotic changes, compatible with metastatic disease. My Urologist/surgeon wants to discuss rib finding with my Oncologist and pet scan reading physician to determine if rib finding may be a false positive!! I have meeting with Oncologist tomorrow.