This study is for men with prostate cancer to see if different treatments work better based on a special test called the Decipher risk score. This test helps to figure out if the cancer might spread. If the score is low, patients will just have radiation therapy (using high-energy rays to kill cancer cells), instead of the usual radiation plus hormone therapy (which lowers male hormones that help cancer grow). If the score is high, patients will try an extra medicine called darolutamide with the usual treatment.

• This study lasts up to 60 months with multiple follow-up visits.
• Participants may receive radiation, hormone therapy, or darolutamide, based on their risk score.
• Risks include possible side effects from treatments, like fatigue or hormonal changes.

To join, you must be 18 or older, have certain prostate cancer conditions, and be healthy enough for treatment. Patients can't join if they've had certain past treatments or other serious health issues. Note: This study involves several visits and assessments over time.