May be a dumb question, but can they accurately isolate the small number of Ca cells before IGRT treatment?

Reason for asking is a friend of mine and I had surgery about the same time. We both are starting to experience a rise in PSA. His doctor (Dr. Smith at Vanderbilt) recommends hormone therapy before radiation. His reasoning is that the cells are so small it's hard to determine where they really are, so go after them with a "shotgun" (HT) would be better as opposed to a "rifle" (IGRT) where you don't really know where you should be aiming.

Since I'm having to make a decision, your comments please?

Usually for GS8 or above HT is recommended prior to start of salvage radiation. I had GS 7 (3+4) and my oncology urologist told me HT isn't recommended or advisable in my case. Tall Allen is right on the money, PC is multifocal. Radiotherapy will radiate the entire prostate bed which hopefully take care of the positive margin and the PSA increase.

A side note, having positive margin increases you chance for long term cure from radiotherapy. This seems contradictory, but if you had PSA increases without positive margin this would indicate possible metastases elsewhere. You can prove this by checking the box for positive or negative margins into any online nomogram.

https://www.mskcc.org/nomograms/prostate/salvage-radiation-therapy