I understand your anxiety bruningk and empathize with you. Unless I missed it I didn't see anything about your staging. Where was the cancer located when you were scanned prior to going on ADT? I presume not confined to prostate? And what was the radiation field?

I've tried to understand the answer to this question and have come across several interesting facts, anecdotal evidence and opinions. Most of this is from memory from things I've read in studies or seen/heard oncos say at conferences or in youtube vids.

1. Disease burden matters. The more extensive the mets, the more mutated the cancer cells and less like the "mothership" they become. Thus they become less susceptible to drugs designed to starve cancer cells of the fuel, DHT or testosterone. I've spoken with guys who've had mets and have been battling PCa for many years, 25+ in one case. I think they had a relatively low, though advanced, disease burden when diagnosed.

2. PSA doubling time is a strong predictor of eventual metastasis and the subsequent transition to CRPC 2-3 years later (though you can become CR without metastatic disease). There is a point of inflection in the curve showing probability of developing distant mets versus PSADT. That occurs around a PSADT of 7 months and increases as PSA decreases further. My PSADT when my PSA took off after RP was around 8 months, so it was aggressive but possibly controllable over the long term. You should ask your onco what your calculated PSADT is based upon it shooting up from 0.05 to .39. There may be some nuances in the calculation I'm not aware of but on the surface it appears you have a pretty short PSADT. Of course this particular graph is probably not directly applicable to your question, but its a morsel of data.

3. Dr Mark Scholz made a very puzzling statement on one of his videos a couple of months ago regarding how long ADT treatments work. He didn't explain the exact context, but his comment was that these days with newer treatments the time to CR has been estimated to be around 17 years. I rewound the tape and relistened to it several times, but that was basically what he said. I'm not even sure how that is possible when the latest ARSIs have only been on the market about 5-7 years, though it is certainly possible to estimate parameters like that given data collected over a shorter period of time. I even called their (PCRI) support staff and asked about it but they had no answer.