I appreciate the good insight and sharing from everyone here. I’ve taken a riskier approach with IADT knowing what that could mean. Surgery in 2022 (Gleason 8) and PSA elevated 4 months later. PET scan and biopsy revealed metastasis to the lungs but the nodules were small and scattered so I was told radiation wasn’t an option. Went on ADT (Lupron and Darolutimide) in April 2023 and PSA dropped to negligible within 3 months. After a year of ADT and experiencing the effects described by everyone here, I decided to try IADT. One oncologist was skeptical of the approach and the other fully supported it. He said there was a lot of good data on IADT and my quick reaction to ADT was a good sign. I’m now 8 months off ADT with PSA negligible but checking it regularly and realistic about the eventual PSA rise. As most have said, life gets so much better off of the ADT but the metastasis makes it risky. We’ll see but as we know every case is different.