When I was diagnosed with Stage 4. I was immediately put on both types of drugs. I first received an injection of Firmagon, as it does not spike testosterone, that same day my urologist gave me a sample bottle of Nubeqa, which is an ARSI. After a month, I had a Trelstar (this is a 6 month injection and filled my prescription for Nubeqa. This treatment started in September 2024, starting PSA was 62, as of March 4th my PSA is undetectable. My urologist explained the dual therapy should be the standard of care. My stage 4 is Gleason 9 and had spread outside the prostate to my pelvic bones and one lymph node. So glad I was treated quickly as the prostate tumor was progressing towards my bladder and rectum. No symptoms now, and tumor has shrunk significantly.