@wwsmith So glad you were able to get that appropriate length of ADT on top of the radiation. A bit terrifying about the lack of sensitivity on the PSMA PET.

Candidly, all along, I've been making all of my decisions based not so much on what the docs say and choose the side effects that are least disagreeable, but on which procedure offers the most recurrence treatment options.

That is why I am strongly favoring RP as first course of action. My PSMA PET show no evidence of metabolically active nodal or visceral metastatic disease and the MRI/biopsy indicates that it was contained within the prostate and not in the walls. So, since it is contained, surgery is a good first course of action. If it it wasn't contained, that Decipher score of .61 would push me toward radiation. And yes, from what you've shared, cells could have escaped detection.

For recurrence after surgery, course of action sounds like IMRT radiaiton/ADT. After that, not sure if its more ADT or Adaptive Therapies based on genetic testing.

I'm sure there are all kinds of variables I'm not comprehending yet, but this is where my head is right now. Thanks for all the great information!!