Adjuvant Radiation Therapry (ART) vs Early Salvage radiology

I had RP on 6/18 at a CoE. As i already knew, showed cribiform glands and extensive left side IDC. Outside that (!) the pathology was OK, with one left side EPE, but negative margins, 3 clear lymph nodes and vesicles. Clear PSMA in late 2024. The other serious negative is my Decipher of 93. Gleason 4+3, 1% tertiary pattern 5.

My RO is suggesting adjuvant radiation therapy (ART) ASAP vs early salvage given my high risk profile. using USPSA, and 3 month intervals. There are some conflicting trials, but most seem to favor ART. the downside is that it is my understanding that if I am not continent (which I am not) when ART is delivered, it will prevent me from ever getting to full continence. Same with ED. if no function at the time of ART, not ever coming back. I guess ART is typically done in the first 6 months post-RP, so I am going to work like hell on continence. ED will be a stretch.

Pretty sobering. ART could extend my life, but at a pretty heavy QOL. Anyone else had to deal with this? Any other recommendations? Surprisingly my CoE doesnt have MRI-guided radiation, so I will probably be looking for an east coast center of excellence that has it. Sloan Kettering, Mt Sinai, Cleveland Clinic. Anyone that has more info on CoE for MRI guided radition would be appreciated. THANKS!

PS disppointed I was never offered neoadjuvant therapy. Some very encouraging results for high risk patients.