At that PSA, .634, have you and your medical team discussed imaging with one of the PSMA PET scans? It may locate where the recurrence is an inform a treatment decision.

Others things to discuss, doublet and triplet therapy - https://dailynews.ascopubs.org/do/would-you-use-doublet-therapy-and-not-triplet-therapy-patient-newly-diagnosed-mhspc both can be for defined times vice continuous.

If you have not already, bring a medical radiologist and medical oncologist into the discussion, preferably ones with extensive experience in PCa.

As I have said in other posts, the SEs of ADT are well known and may vary in each of us for a variety of reasons. There are three things you can do to manage or mitigate:
Diet
Exercise
Manage Stress.

Your medical team can help with others, ask...

Neither while on the 18 months of Lupron and 12 months of Orgovyx did the SEs interfere with my life, They were annoying, some of the actions I took were in retrospect, funny...I never ran the heater in my car, thankfully with dual climate control my wife was able to ride with me. Friends wondered why I didn't swim in the heated pool, once on a work trip a colleague reached to turn the AC down in our car, I told him I'd have to kill him if he did...

During the 12 months I was on Orgovyx wife and I went to Iceland for two weeks and did the Ring Road,. We went to Oregon with friends for two weeks, Crater Lake, Columbia River Valley, Mount Hood, North and Central Coasts. I went skiing in Colorado with friends, rode in the Gamin Unbound 50 with my sister, a 50 mile gravel bike ride through the Flint Hills near Emporia, KS. Most days I went o the gy, rode the indoor bike, lifted weights, swam. I did the yard work, walked the dog, went to several concerts...

For those of us "fortunate" enough to live with this disease (vice the 30k or so here in the US who die of it every year), we make choices that enable us to do so, balancing quality and quantity of life. I've been fortunate to have those choices for 10+ years, of which only three have been actively on treatment, that's a lot of living.

Tonight my wife, daughter and her boyfriend are going to see Moulin Rouge at the Kansas City Music Hall..

Kevin