I've been reading posts here for a few months now, and have found them helpful. I'm now far enough into treatment that I thought I might have some useful experience to report.

My specifics:
68 years old
Diagnosed 4/23 - MRI says it's localized, biopsy says Gleason 6
Plan is to do active surveillance
Subsequent genetic testing of biopsy samples suggests I might be higher risk
Uptick in PSA number in spring of 2024 raises more concerns
New MRI says it's still localized, but a saturation biopsy returns some Gleason 7s
Fall, 2024, we decide to treat it - EBRT and 6 months of Orgovyx
Orgovyx started in mid-September
EBRT started in mid-November, concluded December 31 (Happy New Year!)

Within a week of starting on Orgovyx, I was experiencing hot flashes/sweats - often followed by chills. These have generally declined in frequency, but still persist after 4 months. I think alcohol consumption exacerbates the hot flashes. I think exercise moderates them.

Also within a week of starting Orgovyx, spontaneous morning erections disappeared (they were common before).

About one month in, I had some routine blood work done for a Medicare "wellness check," and my testosterone level was down to 7, from about 480 six months earlier - so the Orgovyx was doing its job.

Four months in, I can still achieve an erection sufficient for penetrative sex, but it takes some work. And on top of that, for the first time since I was in 6th grade or so, I have absolutely no interest in sex! This has been a little disorienting for me, and a little disconcerting for my wife - but we've talked about it, and she's being a trooper.

My testicles have shrunk to roughly half their previous size. This is a little unsettling - but life goes on.

I'm looking forward to getting off Orgovyx in a couple of months - and hoping that some of the side effects reverse themselves.

Happy to answer any questions I can for folks here.