I was more pro ADT until I really did a deep dive into it. There are multiple studies for Gleason 3+4 with slow PSA DT and favorable post surgical pathology, it has no significant effect on PCSM (Prostate Cancer Specific Mortality).

However I may fork out for a ArteraAI genomic test. It's newer and gives better data than Decipher. My Radiologist at UCLA actually said if I could afford it, it would be additional data to make a more informed decision. The results could tip the scale on my posture on ADT. With Orovyx it bring T down much more quickly than the other drugs and T comes back more quickly. I heard lots of exercise and some supplements can help a little with reducing side effects and even some do a low dose estradiol patch if SEs are very bad - it can vary from person to person. Still, if statistically there's no significant benefit for MY particular situation, I'd rather "save that bullet" should salvage fail and not give the cancer a jump start on the eventual progression to being androgen insensitive. Here's just a couple of the many studies that confirm ADT has ot long-term benefit when not having high risk pathology and doing salvage at very low PSA level.

Meta analysis of several studies, concluding it's beneficial only with high risk factors and when being treated a higher PSA levels (they probably had persistent PSA).
https://www.frontierspartnerships.org/journals/oncology-reviews/articles/10.3389/or.2023.10676/full
"A subgroup analyses revealed that the greatest benefit from the addition of ADT was observed in patients with pre-SRT PSA levels >0.7 ng/mL, GS 8–10, and PSM [16]. The French GETUG-AFU 16 trial compared the effect of the addition of short-term ADT with gosereline for 6 months to the SRT therapy (66 Gy) in 743 patients with high-risk factors for relapse and pre-SRT PSA of 0.2–2 ng/mL after RP. In that study, no statistically significant benefit for overall survival was demonstrated"
https://www.redjournal.org/article/S0360-3016(18)31032-0/pdf
"One of the most notable findings from RTOG 9601 was
that pre-SRT PSA was not only prognostic, it was predictive
of benefit from hormone therapy. The interaction test was
significant, which means that patients with lower pre-SRT
PSA are less likely to intrinsically benefit from hormone
therapy, in both a lower absolute benefit (decreased overall
survival by 4.1% from adding bicalutamide for pre-SRT
PSA of < 0.7 vs 24.6% overall survival improvement
from adding bicalutamide when PSA >1.5 ng/mL) and in a
relative sense as well (hazard ratio of 1.13 vs 0.45 for PSA
< 0.7 vs >1.5 ng/mL, respectively). This is in contrast to
other adverse features, such as higher Gleason score, which
did not predict which men will benefit most from the
addition of hormone therapy.
Similarly, GETUG-AFU-16, a trial predominately of
patients receiving early SRT, failed to show an improve
ment in development of metastasis or overall survival and
has thus not shown clinically meaningful benefit for these
patients from the addition of 6 months of a gonadotropin
releasing hormone (GnRH) agonist (2, 5). "

I am looking at having a PSMA Pet scan in a week. I was initially diagnosed with Gleason 3+4 two years ago but before having surgery my PSA was increasing from 6 to a 13. Got another opinion at UCLA, a second biopsy showed I was now Gleason 9. Prostectomy in July. PSA came back quickly after first 3 months. Had a PMA pet scan before I reached one. 1.0 which was negative. I then underwent 39 treatments of radiation in the prostate bed and six months of Lupron. I was below .04 after the treatment for only a couple of months now the PSA is at .6.
This entire time my doubling rate is frighteningly quick. My PSA is low but doubling every month now at .6. Of course I will do a PSMA Pet scan even though it may not show anything yet. What I read tells me my prospects are not great because of the velocity , yet my PSA is still low. I have not seen any recent studies showing the impact of PSMA with early ability to locate where this thing is. Dr. Sholz seems to believe it is a game changer. I sure hope so. Any advice would be greatly appreciated.