I can’t understand why people use Firmagon. It is frequently painful or uncomfortable for those getting that injection. It has to be done every month. You can get a Lupron shot that lasts six months and you get no side effects at all except maybe a sore Injection spot, Something I never noticed. You can also take Orgovyx, A once daily pill that does the same with absolutely no physical issues related to taking it. Get your doctor to change your ADT drug. And no, you do not increase your testosterone by taking ADT, At least not enough to offset the helpful effects of ADT Lowering testosterone.

As for whether you need it, Yes, ADT does make a difference and in your case I would think that adding a second drug like abiraterone or one of the lutamides will give you the best chance of a longer overall survival.

It sounds like you need to find yourself a new oncologist. You want to make sure they are a Genito urinary oncologist, They specialize in prostate cancer, unlike medical oncologist, who work with all different types of cancer. You should consider going to a center of excellence and getting opinions on what you should be doing, because it sounds like you need surgery or radiation pretty darn soon.

If you really have cribriform then you need to get moving on treatment. At a meeting I recently Attended they discussed the fact that if you have a Gleeson 3+4 but also have cribriform, your cancer is actually much more aggressive than a 3+4, Especially if the size of the cribriform is greater than .25 mm. You don’t mention your gleason score or a decipher score, both are very important, Much more than worrying about whether or not your PC is creating its own testosterone.