@datasource Meta studies are tricky because they are usually a compilation of a bunch of different studies and the data is then extrapolated.
Since every case is different, your RO does make a valid point; Many, many, many of the cases did NOT have your high risk component so those men were probably overtreated.
You might be undertreated by using the conclusions of that meta analysis.
In my own case, my PSA rose to 0.18 five years after surgery; a meta analysis - perhaps the same one you are citing - said that there was no benefit at all for using ADT if the PSA was <0.7…
My first RO was totally in favor of no ADT…but how could anyone say how aggressive my cancer really was? I had no Decipher score, Artera or anything else. My gut told me that I needed ADT.
My second RO at Sloan agreed with me and I was put on Orgovyx for 6 months during SRT.
They already KNOW that Your case is more high risk so 12 months is definitely recommended…18 I couldn’t even guess.
I would do the 12 months snd then see where you’re at. If your numbers are low (and they should be) you can suggest an ADT holiday and submit to monthly PSA’s to check for any rise.
No point in even arguing about it now until you hit the one year mark, IMHO…
Phil