Hi Sebastien,
Your consultant may well have a good reason for not adding HT, at least at this point but it is certainly a question that you could ask.
Yes, PCa is indeed very complex and sometimes medical opinions differ on diagnosis and treatment. Biopsy can miss tumours completely or not find the most mutated cells. Better scans are becoming available but even these sometimes fail to enable tumours to be identified yet alone microscopic cancer cells. My own case illustrates this. Following RT (in Germany), my consultant at The Royal Marsden considered that my slow but persistently rising PCa was likely due to some re-established cancer in my Prostate and an MRI scan showed this to be the case. I was referred to the University College London Hospital who did a further biopsy and scans and I was accepted in a study to have HIFU. UCLH also said they believed I had a cancerous iliac lymph node as it showed an uptake of choline on an MRI scan. They suggested I start HT. However, I referred the scans back to The Royal Marsden who said they were not convinced this node was cancerous and recommended I did NOT start the HT. I also sent the scans to myRT treating hospital in Germany and they were of the same opinion as the Marsden but stated that although there was some evidence of choline uptake, the size and shape of the node had not changed since the last check up scans I had there in 2011. However, they did suggest that if the PSA rose to 0.70 (in my case), I have a 68 Gallium PSMA scan and if appropriate have a minimum of 3 month's HT followed by some more radiation. My PSA is now 0.73, (having been at a nadir of 0.39 after HIFU) but further recent scans lead UCLH to believe that there may still be a very small tumour in the prostate. So the node and now the prostate are areas of suspicion.
This shows that it is not always possible to get a definitive opinion even from experts because of differing interpretations and limitations of scans in particular. I do believe it is worth pursuing possibilities with ones consultants and I have indicated my willingness to have a further targeted biopsy of the prostate and more HIFU to eradicate any cancer found. I have also asked if a biopsy of the suspicious node could be done at the same time and my consultant says he will take advice on this.