@jeffmarc Yes having recently been in this exact situation I find these lines to be really ambiguous. I was at .23 when radiation started but PSMA was negative. I got radiation to pelvis and bed. As the stats would show there is in the low 30 percent probability that the recurrence is ONLY in the bed. I am getting four months ADT with what must be a corresponding 60 odd percent chance that the radiation did not get my recurrence. Now we know I have a recurrence somewhere. But because it didn't show on PSMA I am getting 4 months whereas if it showed on my spine etc I would probably get years of ADT and doublet therapy. It seems an odd dichotomy based solely on a scan result when the PSA tells the tale. Also in addition to the confounding variables others have mentioned, I would like to see an analysis when time to recurrence and doubling time are considered in addition to the initial staging. Finally, I have not read the article yet, but Jeff with regard to the studies saying start before .25 regardless of PSMS, didn't they also show benefit to combined radiation and ADT? That is my recollection.