Superior metastasis-free survival for high-risk PCa treated with RT vs RP - study

Here's an interesting study, from 2017. It supports dose-escalated RT + ADT for high-risk cases. Many of us here have had pretty much that protocol. It's a retrospective study so it has the usual inherent selection-bias risks. But it does use quite contemporary treatment protocols, with RT using the levels currently being delivered. Only two patients had less than 75 Gy dose.

Superior metastasis-free survival for patients with high-risk prostate cancer treated with definitive radiation therapy compared to radical prostatectomy

It's encouraging that metastases were delayed by RT, though also of note there was no difference in overall survival vs RP.

From the article:
Conclusions
This propensity-score-matched analysis from a single
institution using contemporary treatments corroborates prior
reports that dose-escalated RT as primary treatment for HRPCa
is at least comparable with RP for disease control.34-36
Our data suggest that RT with concurrent/adjuvant ADT
may be superior for preventing development of distant metastases.
When considering the higher toxicity associated
with RP followed by either adjuvant or salvage RT and the
higher rates of salvage therapy overall, definitive dose escalated
RT and ADT may be an overall better primary
therapy for men with high-risk prostate cancer.

RT w/o ADT was comparable with RP. If ADT is responsible for the improved RT outcomes why isn't ADT also an option to use together with RP for high-risk cases? But then falls one argument for RP, that you can avoid ADT and its SEs.