I was on Lupron for 7 years and Orgovyx for 1. Yes I have some brain fog, people rarely notice. Yes, it deteriorated my muscles so I walk the track, across the street, twice a day and go to the gym for an hour 3 times a week. I let my muscles go for 6 years and after 4 months my muscles have been coming back. Make sure to exercise regularly. I am 77 doing this and my testosterone is 7.

I had cardiac issues when I started Zytiga after being on Lupron for 4 years, never had an issue with Lupron alone. I know cardiac issues are possible but after years of weekly advanced prostate cancer meetings I do not recall anyone mention it.

Fatigue can be a problem, for some it is a real problem. You probably would only have this issue for 6 months.

With a Gleason of 7 they usually recommend ADT for 6 months. That reduces reoccurrence.

IMRT combined with SBRT to the prostate reduces the number of IMRT sessions. Done frequently. Something to think about. There are many other treatments like HIFU, cryotherapy, TULSA-PRO or more.