Where are you getting treated? Do you have a Genito urinary Oncologist as your team lead? The fact that you are undetectable makes adding the other drugs questionable but a GU doctor would know best. ADT has a lot of negative side effects, you do want to defer them as long as possible.

Problem is you are likely to have reoccurrence due to your complex case, it’s probably just a matter of time. If you catch it right away, then going on ADT can stop it from growing and spreading. For now you have a few years without ADT which is something you would appreciate if you were on it. So many people wish they could just get off of it because the side effects drive them nuts. Getting your doctor to put you on monthly PSA tests would at least allow you to catch it as soon as a reoccurrence happens.

I did go 3.5 years after the prostatectomy without any drugs before it reoccurred, but my case did not involve any complications such as yours did. I found out 12 years later I had BRCA2 so that’s why it keeps coming back. If they had known that in the beginning, they probably would’ve put me on ADT.

Don’t know if there any Mayo clinics in your area, but doctors there would be able to treat you to keep you optimally healthy for a long time.