Well, yeah, not sure what you mean by "He already has had such a drastic change in the way he feels since prostatectomy." A year after surgery most side effects have disappeared less possibly ED and incontinence. If he is dealing with depression as a result of either, well, is he willing to seek counseling?

Given the clinical data you describe, he is high risk, ergo, his choices are ignoring and face the consequences, or, confronting it and dealing with it. I can well remember my pity party after my urologist called me with the biopsy results. He's entitled to a moment but then it's time to put the pity behind and get on with the business of managing his prostate cancer and living his life.

As I've said before, I've peeked behind the door of death by prostate cancer, it's a no for me and my medical team knows it.

Attached is my clinical history, I was diagnosed at age 57 in January 2014, high risk - GS 8, Grade Group 4, short time to BCR, rapid PSADT and PSASV...yet, just over 11 years later, here I am. I have packed a lot of living into those years, vacations, birthdays, graduations, anniversaries...wife and I are heading out to Sedona in April and then in May Lake Tahoe with our daughters.

Have I liked being on treatment, heck no.

There are ways to manage and mitigate the side effects:
Diet
Exercise
Managing stress

For me, the only difference being on versus off treatment is not in what I can do, just how I feel doing it. I've been skiing in Colorado with friends, done the Bataan Death March (26-mile hike) in White Sands and the Gravel Unbound, a 55-mile gravel bike ride through the Flint Hills of Kansas and travelled the Ring Road in Iceland with my wife while on ADT. The only restriction of treatment has been when doing radiation since it's continuous so no "vacations" during that time.

Mainstream clinical practice for his clinical history may be doublet or triplet therapy - https://pubmed.ncbi.nlm.nih.gov/36058809/, whether or not it is for a defined period or continuous is a discussion with his medical team. A question to discuss with his medical team maybe be whether to include a ARI to his current regimen of Orgovyx and radiation. By the way, where is that radiation too, the prostate bed, or, does it include the pelvic lymph nodes.

There are resources to assist you and him in understanding this journey, the Prostate Cancer Foundation is one source - https://www.pcf.org, the Prostate Cancer Research Institute is another - https://pcri.org/

Both he and you may want to inform yourselves about the terminology, definitions and treatment guidelines associated with prostate cancer. They can guide your discussions with his medical team - urologist, oncologist, radiologist and the associated specialties.

Hs, and yours. life is different now, but there is a lot of life left.

Kevin