All of the documentation I have seen recently points to the fact that earlier radiation is really good if you have certain issues. What your doctor says about waiting for the PSA to rise is old news and has been countered by some doctors that have found the results are not good for people that have certain prostate cancer issues.

Here are some information about it from a Doctor who is a very highly respected and very knowledgeable. @surftohealth88 Originally posted this link.

There is evidence to support the use of adjuvant radiotherapy in high-risk patients. EORTC 22911, SWOG 8794, and ARO 9602 all showed a biochemical progression-free survival benefit for adjuvant radiotherapy, compared to observation, for patients with adverse pathologic features.2-4 However, the use of adjuvant radiotherapy in clinical practice remains low (estimated < 10% of patients who meet the criteria).5

Dr. Efstathiou concluded as follows:
* Early salvage radiotherapy is favored over adjuvant radiotherapy in most patients
* Consider adjuvant radiotherapy in otherwise fit, motivated, very high-risk patients with ≥2 of the following risk factors:
* pT3b-4
* Gleason score 8-10
* pN+ Lymph node Metz
* Decipher score >0.6
* In high-risk patients, use lower thresholds to initiate ‘ultra-early salvage or adjuvant-plus’ radiotherapy
* If giving adjuvant radiotherapy, it implies high-risk disease. Thus, Dr. Efstathiou would recommend treating the prostate bed and pelvic lymph nodes, in addition to short-term versus long-term ADT, depending on risk factors
* May consider genomic classifiers or artificial intelligence tools to help with informed decision-making
* The goal is to avoid (or delay) radiotherapy in those who we can, without missing a window to cure patients who are guaranteed to recur

Here is a link to the original article.
https://www.urotoday.com/conference-highlights/apccc-2024/151546-apccc-2024-debate-how-to-best-manage-a-fit-patient-with-high-risk-localised-and-locally-advanced-prostate-cancer-how-to-select-patients-for-adjuvant-therapy-after-radical-prostatectomy-and-how-to-treat-them.html