You have received a great deal of input...

Here's my clinical history, 10+ years now, seven off treatment, three on.

I'm 68-1/2, so still have expectations of 10-15 years minimum, maybe more...?

So, my decision are based on that expectancy, the clinical history of my PCa and current clinical data such as PSADT, PSAV, imaging...al; my data says high risk - GS, GG, time to BCR, PSADT and PSAV...so, my decisions are based on my risk.

There is not a wrong decision you can make.

You could do nothing. It is possible that it could be eight years or so before your PCa starts to present problems, you'd be 87, hopefully! You likely could deal with it then, who knows what advances will be made by then, certainly we are making progress in more individualized and precision treatments using genomics.

You could choose MDT only, that can slow down your PCa, unlikely a cure because of system or micro-metastatic PCa. I've had three different radiation treatments, SRT, WPLN and SBRT, 69 total, 155Gya. Zero side effects, then again, I have a pretty damn good radiologist. The use of metastasis-directed therapy (MDT) is rapidly increasing in the setting of oligometastases. STOMP and ORIOLE, the only two prospective trials of stereotactic ablative radiation versus observation in metachronous oligometastatic castration-sensitive prostate cancer (omCSPC), demonstrated that MDT, as compared with observation, prolong androgen deprivation–free survival1 and progression-free survival (PFS)

You could choose MDT and short term ADT, say Orgovyx. I finished 12 months of it in April, July T was 312. When I did 18 months of Lupron from Jan 17-May 18, (the last shot was May 18, 90 days soroughly July when it would have started to clear) T recovered to 135 in October, 400+ by Feb and by the time I started treatment in April 23, 600+

Why did my T recover, who knows, there is some discussion of the role exercise plays in it. I exercise pretty much every day, active vacations.

While on ADT, I had the standard side effects, mild fatigue, muscle and joint stiffness, hot flashes and genitalia shrinkage. Annoying but not life altering.

...data from the HERO trial... we see a rapid decrease in testosterone with relugolix. The day four mean T-level was down to 38 nanograms per deciliter. You can see here a rapid decline for relugolix with a more gradual decline up to about five weeks for leuprolide before it reached castrate levels...testosterone recovery, which is also important. The percentage of patients with testosterone greater than 280 nanograms per deciliter at 90 days was 54% for relugolix and 3% for leuprolide, which was statistically significant

54% sounds great, unless you're in the 46% group! The 3% clearly sucks.

Kevin