In a nutshell, ADT has thankfully provided a lifeline to many prostate cancer patients who really had no other choice in order to keep the disease at bay. And for those of us with Gleason 7 (4+3), it has been a standard of care to supplement radiation with short course ADT to provide a boost to the effectiveness of radiation against biochemical recurrence. When I had to make my decision to supplement SBRT Proton with ADT in 2022, I admit it was a struggle intellectually to justify the action knowing the decision was being based on trial results by then decades old and in the context of potential metabolic and quality of life impacts that had to be measured against any negative odds of not agreeing to take the shot(s). It is natural that most of us want to approach this disease with a one and done strategy. That being said, my sense is that most urologists and radiologists who themselves are diagnosed with either grade of Gleason 7 cancer confined to the prostate today would forego ADT based on newer study results and new diagnostic testing advancements. Just as I was blessed with being treated with more advanced protocols (which at the time included ADT), than many who preceded me, future men afflicted with this disease will experience even less quality of life impacts than I did. I have no regrets in taking the ADT shot when I did. That said, if you have newly diagnosed 4+3 Gleason confined to the prostate today, I believe, at minimum, you need to think very hard about the net quality of life and survival benefits of chemical castration via ADT. Just my honest gut assessment.