Good morning. I can only give you my experience which, of course, is not a recommendation for treatment. That is between you and your MO. I am 71 years old and was diagnosed at age 68. My pre treatment Testosterone level was in the 500s.

I had a biopsy of my prostate performed in 8/21 after several years of waxing and waning PSA from about 4 to 7. It was diagnosed as focal G8 in the location of a 1 cm enhancing nodule on MRI. I underwent RP in 10/21 after extensive consultation with multiple urologists, RO and MO at COE. Six months after my surgery my PSA rose to 0.37 and a PSMA PET scan revealed a solitary met in my mid thoracic spine. Again, consultations. Based on recent trial data I had SBRT (radiation) to T8. Four months later my PSA had risen to 4.5. Repeat PSMA PET showed no activity at T8 but a new positive left pelvic node.

At this time I did extensive research about aggressive treatment and had a Zoom consultation with Johns Hopkins. I was thoroughly impressed and began immediate triplet therapy (3 month Lupron injection, Darolutamide and Taxotere chemo x4). My PSA dropped to undetectable after 2nd chemo treatment. My MO is a very experienced prostate cancer physician who is Director of the Prostate Cancer Research facility at Hopkins and has written (or co-authored) over 500 peer reviewed articles on prostate cancer. He treats numerous patients with oligo metastatic disease and has been involved in numerous trials. I mention this only because his approach is somewhat different from the current SOC.

After the 3 month conclusion of the chemo he discontinued the Darolutamide. I underwent whole pelvic radiation with boost to the prostate bed and the one positive node on repeat PSMA PET. I continued on Lupron for one year with 3 month checks of my PSA and Testosterone. PSA remained undetectable and T < 3. After the one year mark he discontinued the Lupron (last injection was 7/23). My PSA remains undetectable (had annual PE this week and uPSA test < 0.014). My T has only gone up to 30s. They tell me return is variable and can take more than a year to normalize (based on age, prior T level before treatment and length of time on ADT).

I am told that if I reach the 3 year mark post treatment with return of T and PSA undetectable, my longer term outlook is good. If my PSA rises he will do a repeat PET and radiate any visible mets (return to Lupron is TBD).
Treatment for prostate cancer is changing so rapidly that articles published several years ago may not be cutting edge. Who knows what the right answers are? Being a retired physician with over 40 years experience I decided I needed to find a team I trusted and follow their recommendations. The ultimate decisions are mine, of course, but I don't try to direct my own treatment by something I read on the Internet or because another patient suggested so and so course of treatment. That's just my plan. Everyone is different.

I wish you and everyone battling this disease the best of luck and prayers.