I am 65 with 3+4, PSA around 5 (varies with every test), PSMA negative for spread outside capsule, but MRI showed possible extracapsular extension, so more aggressive than 3+4 usually is. My RO recommend the Artera test which showed significant risk reduction in distant metastasis with short term (6 month) ADT, so I started Orgovyx 3 weeks ago. No side effects so far. I am also very active, running 5 times/week and lifting 2-3 times. This seems to be key to controlling side effects. I just met with my RO yesterday and start proton therapy in about 3 weeks. I also consulted with UFHPTI and would have gone there if closer. I didn't really want to move to JAX for 6 weeks. Good luck with your decision and treatment!