I'm in https://connect.mayoclinic.org/member/00-5f1d090c7f9cb13c363032/ camp...

High risk PCa generally necessitates aggressive approaches to treatment, mono-therapy is not in that category!

From the clinical data you describe, doublet therapy, perhaps triplet therapy may be a topic to discuss with your medical team. They can also go over the which ADT and which ARI choices, their reasons why and considerations. As others have said, Orgovyx has advantages over Lupron - lower CV side effect profile, no flare, faster and higher sustained castration rates, quicker recovery of T, the hot flashes and fatigue may be less severe. Same with the ARIs, which ones you take with prednisone, crossing the brain blood barrier, interactions with other medications...

Here's one article, you can find others https://dailynews.ascopubs.org/do/would-you-use-doublet-therapy-and-not-triplet-therapy-patient-newly-diagnosed-mhspc

In my case, I chose triplet therapy given my clinical data - GS 8, GG 4, 18 months to BCR, PSADT and PSAV

Also, read through the NCCN guidelines - https://www.nccn.org/patients/guidelines/content/pdf/prostate-advanced-patient.pdf, they can also guide your discussion with your medical team, which, if not already, should include a radiation oncologist and medical oncologist, with expertise and experience in treating Advanced PCa.

When you say "apparently contained..." by what criteria do you say that, have you had imaging, conventional or PSMA? I ask because conventional imaging is not very sensitive and even PSMA imaging has its limitations given micro-metastatic PCa.

Kevin