Thank you both for the helpful comments and questions. I very much appreciate your responses to my questions as well as when I have read your insights to other posts.

With this last reoccurrence, I was scheduled to have ADT and radiation to the hip by Mayo. When starting Lupron again, my local oncologist reviewed my PET scans back to 2022 and worried that while the most recent PET scan only clearly showed evidence in part of the hip, she saw evidence of multiple areas of bone metastases when comparing scans over the past few years. She worried that even though there was very low PSMA uptake in other areas, there were increases in size and location over the years. Based on my age (58, diagnosed at 51) and fitness level, she suggested hitting it hard. I also have had a low PSA since inception (it only peaked at 2.0 before surgery in 2017). I spoke to Dr. Kwon and he agreed with the strategy. So as much as I would have preferred radiation again, having two great minds align convinced me to take on the triple therapy.