Salvage radiotherapy after biochemical recurrence can provide sustainable PSA response and a survival benefit in men with a PSA doubling time less than 6 months.27 The timing of salvage radiotherapy is debated but early treatment is probably beneficial for patients with long life expectancy and non-favourable histopathology.28 29 Thus, in our study men with Gleason score ≤3+4=7 without biochemical recurrence 5 years after radical prostatectomy, hormonal treatment or salvage radiotherapy is unlikely to substantially reduce risk of metastases or prostate cancer death. This evidence concerns the gene KLK3 and prostate cancer.