Since my Decipher test showed low risk cancer and still confined to the prostate, I was offered, but allowed to decline ADT. The proton therapy did treat my seminal vesicles too. I declined ADT.

I just read a study from about 8-10 years ago in The Journal of Urology that showed 100% of men on ADT lost their ability to orgasm after a period of time. Their "Conclusions" from the study:

"CONCLUSIONS: ADT results in significant orgasm dysfunction with loss of orgasmic capability in all patients with time and reduced intensity and increased IELT in all. Patients undergoing ADT should be counseled regarding changes in orgasm."

Note: ILET is Intravaginal Ejaculatory Latency Time.

The study reference can be found at: https://doi.org/10.1016/j.juro.2013.02.2752 . I didn't see where the study addressed what occurs after stopping ADT, however. I do think urologists need to keep up on their own field specialty and not be afraid to speak frankly with their patients about all possible side effects. I think they "assume" their cancer patients are more concerned with the cancer than with the side effects, but they would be wrong a lot of the time, yes?