I whole-heartedly disagree that G9-10 disease is going to recur locally rather than systemically most of the time. That flies in the face of everything we know about gleason score and how it relates to development of distant metastatic disease.
Also, this is a review of purely academic institutions with mostly good track records (UCLA, Cleveland Clinic, Hopkins, Dana-Farber, Fox Chase, Mt. Sinai, Michigan, Beaumont) with the only ones I don't recognize being the one from Norway and the West Virginia one. Despite what is reported in series as being 10-15% (and I'd like you to cite that this is in truly 'high-risk' disease), these aren't chump urologist out in the community, and they're still getting 40%+ SM.
Patterns of care consistently show, on a national level, that salvage radiation is woefully underused, and the 40% of patients who got radiation after surgery is higher than the general population. This is our frustration, as a specialty, with urologists all across this country. Urology frequently sells unimodality therapy to a patient that has a 75-90% chance of requiring multimodality therapy.
That is why nearly all of us are in favor of multi-disciplinary clinics where a patient with prostate cancer meets with surgeon, rad onc, med-onc all on the same day, prior to being scheduled for surgery. Guess where the push back to this is coming from?