All,
I asked a somewhat similar question in a different thread that discussed the Kwon approach of waiting for treatment until a met shows up in a PMSA PET scan. Much of the discussion there is recounted in this thread, with some helpful additions here. I will repeat one point I made that is relevant to those with aggressive pathology and very high Decipher scores:

On the question of "who benefits from ADT and is it worth the side effects"? I just had an appointment with my RO at Johns Hopkins where he considered whether to add ADT to SRT. (Short story: I had RALP in 9/25; PSA still low but rising; aggressive cancer (IDC, Cribriform, EPE, Decipher .89, but clean margins and clean pre-surgery PET). The determining factor for him to add ADT was the detailed report that accompanied the Decipher one page summary. It showed I had Luminal B, an aggressive subgroup. The trial (which has not yet been peer reviewed) NRG GU006 (BALANCE) showed a clear benefit of adding apalutamide to SRT. If you have a high Decipher score, ask your doctor to get the detailed report that accompanies the one page summary. You can also google "NRG GU006 (BALANCE) and Luminal B" to see a discussion of the study.
Subsequent MRI and PET scans confirmed 2 pelvic nodes, so now the question for me is, in addition to SRT, which drug(s) will I get and for how long? This will be answered on 6/16 during an appointment with my MO.