Excellent points and suggestions already. When I was diagnosed with locally recurrent PCa this summer, I faced a similar decision—salvage radiation with or without short term ADT? NCCN guidelines also indicated that ADT was a +/- treatment option in my case. I opted for no ADT after conferring with three oncologists (2 were pro ADT, one was agnostic). A very personal decision, and someone else may have opted for ADT.

Critical to my decision making was an evaluation of my desired "end points” as they say in the medical literature. What were my goals with treatment? Freedom progression at five year, ten years, more? Maximum life span? Quality life with whatever time I have left, be it three years, twenty years, or more (I’m currently 73)? And how did my wife feel about it all? Tough questions to answer, but they were really important and also helped me evaluate medical literature and clinical studies as they applied to my situation. I also discussed those goals with the oncologists.

My PSA at the time or recurrence was only 0.1 (previously was undetectable), and it remained the same when I started IMRT three months later. Scans and a DRE however confirmed a small lesion in my prostate bed. My low and stable PSA, and ten years between my RP and recurrence were factors heavily in my favor. If my PSA has been greater than 0.2, or risen between initial diagnosis and start of treatment, I may have decided differently about ADT.

Best wishes going forward.