As yet I do not really get why a short PSADT requires an early start of ADT. Yes, it indicates that you are a high-risk patient and you should measure the PSA value more often than usual. But in the end, you just reach the PSA value, which you use as a trigger to start ADT, earlier. As I see it, this should be 10 ng/ml as I already explained.
I did radiate my mets after a PSMA PET/MRI with SBRT to delay progression. This is not as easy as it may sound. The PSMA PET report describes the
locations of the mets but the RO may not find these when he is looking at his planning CT. He does not have a PSMA PET/CT.
I think it only makes sense to use SBRT radiation. An IMRT radiation stretching over 45 days with the risk of side effects, just to delay the progression by about
a year, is too much effort I think.
Then, if you have bone mets you have to find an RO who is ready to radiate these with SBRT using a dose of 3x10 Gy or similar. The common radiation with IMRT is palliative to treat bone pain and will not destroy the mets.
Finally the mets may recur at
locations difficult to radiate.
As an alternative you can choose an extended LND. But the surgeon uses a standard template for selecting the lymphnodes to remove and may miss the met you saw on the PSMA PET. This is not unusual.
In spite of all this, I will try to radiate recurring mets again with SBRT.