It just shows Bri that wherever you are in the country Oncos have their own ways and techniques based on their own personal case studies. But all actions are still within NICE guidelines I believe. For instance my PSA is now well over 100 post surgery but I haven’t even been offered HT nor Chemo , because all scans show zero and because I constantly refuse the normal next line treatment of RT. I had a 20 minute phone consultation with my GP today who is a cracking bloke and also head of palliative care at a local cancer hospice. He went right through my case and discussed my last two scans in proper detail ( which my Onco hasn’t ) , and he absolutely agreed in my instance that it was the right decision to avoid RT given the scores.
Judging by all the info on this forum yes your next line of defence is HT , and if you’ve had RT I think psa 20 is normal. It could be ages before you reach that. I believe SRT fails in 50% of men but you’ve bought yourself some good time. Even now the tiny recurrence may be localised where the rays missed. I’m no expert but in your shoes I’d let psa rise substantially to say 5 or more then get a PET before agreeing to nasty systemic treatments