Sounds like you have your arms well around your case and that you are approaching all of this with a very level head. The ADT decision will be a very personal one despite the results of more recent research which shows ADT for 4+3 is likely not as compelling with all the new scanning technology. Please let me know what you decide after your future consults on the matter. ADT certainly has its place but I hope you and future 4+3 patients can confidently avoid using it. I am in well above average shape and overall metabolic health at age 73 and very active. Despite this, ADT impacted my overall muscle mass, even with exercise offset and targeted supplements, etc. If I had had the new research results in 2022, I can only tell you retrospectively that the doctors would have had to give me a darn compelling argument to do ADT based on my overall situation. Stay in touch pal!