Unfortunately, Rocky, it IS a crapshoot when it comes to actually ‘seeing’ what’s going on at a cellular level.
PSA’s and PSMA’s are NOT infallible - not even close - but right now it’s what they use to measure success or failure.
I read your brief history and in spite of all the intense genetic testing you had done at the center of excellence, the factors which stand out to me the most are your dangerously high Decipher Score and PSA velocity after surgery.
My surgical pathology was Gleason 4+3, clean margins, no lymph spread, etc. There was no Decipher test at that time. It took 5 years for my PSA to reach .18 and I just finished salvage radiation and am on 6 months ORGOVYX ( last month).
Now if I’m on 6 months ADT for something that took 5 YEARS to return, how long should you be on it, when your PSA rose so quickly after surgery and your Decipher Score showed such an aggressive profile?
It would seem to me as a layman that all things being equal, you should be on it longer than 6 months….how long I certainly don’t know. Orgovyx is really not that bad and others on the forum have been on it for over a year with no significant side effects. I realize you are concerned with your situation becoming castrate resistant if you stay on ADT too long but I think you’d have to be on it for a much longer time for that to happen. Best…