This study looks at treating prostate cancer based on a Decipher risk score, which predicts if cancer is likely to spread. The Decipher risk score is calculated by looking at the activity of 22 genes in the prostate tumor. Patients with a low score might receive less intense treatment, like radiation therapy alone, which uses high energy to kill cancer cells. Those with a high score might get a more intense treatment, adding the drug darolutamide to regular hormone and radiation therapy. Hormone therapy drugs reduce or block male hormones that help prostate cancer grow.

• The study lasts for 5 years, with follow-ups every few months.
• Participants will be checked regularly to see if cancer spreads or comes back.
• Possible side effects include those from radiation, hormone therapy, and darolutamide.

Consider joining if you are 18 or older, have prostate cancer, and meet specific health criteria. Avoid if you had prior prostate surgeries or treatments. Participating can help find better ways to treat prostate cancer based on personal risk scores.