Hi Gene and Welcome-
I can see a case for all of their points:Adjuvant radiation
You certainly have some risk factors: high Gleason score, positive margins,T3a, and high Decipher score. Other factors that seem to be important are the length of the positive margins and the Gleason score at the margin. As you probably read, three randomized clinical trials in the last few years have proved that adjuvant radiation improves outcomes by about
50% over "waiting." I put "waiting" in quotes because the 3 trials had no set standard for waiting. Clearly, they often waited way too long. There are a few clinical trials in progress (with results expected in several years) that randomized men to adjuvant vs salvage radiation when their PSA rises to 0.2 ng/ml.
Walsh at Johns Hopkins favors adjuvant radiation in cases like yours:Extraprostatic extension (EPE) alone is not enough to justify adjuvant radiation
I would also note that Decipher is very good at predicting which cancers are unlikely to metastasize, at least in 5 years. But it is not so good at predicting the ones that will.Genomic classifier can help identify patients who may not need adjuvant radiation.Early salvage radiation
The problem with adjuvant radiation is that it sends many men to radiation who might never need treatment. Also, a recent study showed that men who waited at least 7 months after surgery did better on urinary and sexual issues than if they had radiation sooner. So as a compromise to allow for greater healing and to protect men from overtreatment, some have proposed the idea of "early salvage." That means waiting until the PSA on an ultrasensitive PSA test rises to some point where further progression is immanent, but doing it early enough that there is low chance that it has metastasized. This has emerged as a viable option in the last couple of years.
Here are a couple of articles that explain all this:Very early salvage radiation has up to 4-fold better outcomes and saves livesHow soon after surgery should salvage radiation begin?Will any radiation (adjuvant, early salvage or salvage) be effective?
The question you didn't ask, but that I think you might want to give some thought to, is whether it is worthwhile to pursue any salvage radiation therapy at all, or whether you may be better off going straight to lifelong hormone therapy. That would be the case if you discover distant metastases, or if the likelihood that they are already there is very high.
Your relatively low PSA pre-surgery argues against metastases, but there are rare kinds of PC that don't put out very much PSA. It is also very hard to detect even with the best new PET scans when current PSA is low (which is probably the case with you). Here is a nomogram that may help you if you decide to wait for your 3-month PSA:Probability of remaining recurrence-free after salvage radiation
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results
•SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.2,no lasting urinary, rectal or sexual SEsmy PC blog