The situation after Zytiga

I'm chuckling at the thought that any of us would know enough to answer your question. But what does occur to me is that you have followed this protocol halfway and now the question is whether to keep going. Something must be inducing doubt in your choice this far.
The two things you note seem somewhat incompatible: If your biopsy only showed 3+3, why was your PSA 21? My guess is that you and your team are trying to reconcile that, and that the treatment strategy is based on the theory that you have prostate cancer that didn't show up in the biopsy. If you and your team still believe that, proceeding with a radical prostatectomy seems like a reasonable choice. My assumption is that the "time is good" because right now the spread of cancer from these (not showing up on the biopsy) cancer cells will be minimized.
Of course, if you do have the RP, then afterward you'll get a complete pathology report on the whole prostate, which will guide further treatment.
But then, if your very high PSA was somehow not due to cancer, then you will have suffered for the suspicion of disease, not for the disease itself. And perhaps therein lies the doubt!

My PSA has risen from 2019 and PSA value was double per year. My ignorance and careless lead to high PSA.
I had got my first biopsy that showed 10 core with 3+3 score. I just wonder if the Zytiga could cure the cancer
and if it is possible that I do not need surgery ?

Echo Spino.

Well, to boldly go...

My understanding is that ADT alone does not kill PCa, but can be effective as part of the therapy to "weaken" PCa and make RP, or subsequent salvage radiation in my case, more effective.🤔

My ADT was initiated after RP and prior to salvage tx. My PSA had dropped in response to the ADT, which was expected (and welcomed by me), but it was only part of the treatment.

I proceeded w/ the whole pelvic floor and pelvic lymph nodes radiation, completed both txs and 6 mos later PSA was undetectable.

So...was Zyitga a complete treatment or only part of the plan?

Clearly a Q for your medical advisors.

@dwang567, what did your cancer team recommend? What did you decide?

My doctor just said this situation is good time to perform operation, because there could be no incontinence and I do not like surgery or radiation treatment, I wonder it is possible that detected no tumor could be maintain? If it is not possible then I should follow the doctor's opinion.

My understanding is that Zytiga restricts testosterone which feeds prostate cancer. Little, if any of the cancer, dies from that, but the PSA drops to sometimes "undetectable." If the biopsy results were correct, the cancer is still there and will *very likely* reassert itself as the effect of the Zytiga eventually -- as I understand almost always does -- wears off. (I have heard of -- but can't verify -- "hormone therapy," actually anti-hormone therapy like Zytiga, working for many years for SOME men.)

When my husband started Zytiga in January of 2020, his oncologist told us it was effective for an average of 16 months. My husband was lucky and it kept his cancer in remission for a bit over 3 years.

And yes, neither Zytiga nor other similar drugs kill the cancer. They reduce the testosterone which reaches the cancer, suppressing its growth for a time.

Is it continuing to suppress testosterone?

Zytiga stopped working after three years, and my husband has just begun treatment with Pluvicto. It worked wonderfully well for those three years, and we knew it would eventually stop working, so we are glad he was put on Zytiga.

I am on zytiga/orgovyx for nearly a year maintaining undectable psa. I am under a great deal of pressure to get radiation. My quality of life is quite good now and I would rather play the adt out for as long as I can. Did psa failure cause him to stop xytiga or some other reason?