Jeff, I really appreciate you taking the time to share this graph and the articles. They highlight concerns that are very real for those of us with IDC and cribriform features. Seeing the numbers laid out visually makes the risks you’ve been pointing to much clearer, and I’m grateful you’ve brought that perspective here.

At the same time, I remind myself that the graph comes from retrospective studies — looking back at patients rather than assigning treatment randomly. That makes the results valuable as a warning signal, but also subject to confounding factors (for example, salvage radiation was often given much later in the past, when PSA was already higher). That difference alone could explain much of the gap. This is why the randomized controlled trials are so important: when men were randomly assigned to adjuvant or early salvage radiation, outcomes were the same. The limitation, of course, is that those trials didn’t single out men with IDC or cribriform disease, so we don’t know if our subgroup behaves differently.

To me, this doesn’t change the path I’m on, but it does reinforce your main point: with our biology, we need to keep the leash very short. That means ultrasensitive PSA every 3 months, being ready to act on a confirmed rise, and making sure tools like Decipher and advanced imaging are in the discussion with our doctors. I’ll definitely revisit some of this with my Mayo team at my next follow-up.

Thanks again for putting this information out there. It helps me think through the trade-offs more clearly, and I hope we can keep this conversation going.