Your husband has a very aggressive form of cancer. Unless he stays on ADT or something similar, he is not going to live a long life.

Yes ADT Can cause a lot of fatigue, especially if you don’t exercise regularly. The problem is, without it the cancer will continue to grow, and it will not be pleasant.

You could talk to your doctor about monotherapy, Something like Darolutamide or apalutamide may work to reduce the cancer growth, But unless his testosterone is also managed, those drugs cannot work fully, and his PSA will probably continue to rise, just not as fast.

My father died of prostate cancer. When I was young, he had his teeth ground down and crowned without Novacaine and came to dinner every night, He had an incredible pain tolerance. He died of prostate cancer. In the last few weeks you couldn’t even talk to him because he was on so much painkillers he was not able to communicate.

Yes, ADT has it drawback, I was on it for eight years. I should know. If you can’t handle the fatigue, then you should speak to a palliative care doctor. They will work with him to resolve the problems he’s having with ADT.. Yes, he will lose some of his sex drive if he goes on ADT, But he could live for another decade. What is more important? If they put them on ADT plus abiraterone then the fatigue can be pretty bad, Adding more prednisone can make a big difference, Going to 10 mg of prednisone has helped people I know relieve some of the fatigue problems. ADT with Darolutamide would have fewer side effects. If he is on abiraterone And has heart issues it is not the right drug. I had to quit taking abiraterone Because of the effects on my heart, Darolutamide does not have similar problems.

I’ve heard from multiple people that have had prostate cancer tumors in their lungs. Going on ADT plus an ARSI can reduce those tumors, Had somebody reported they completely disappeared.

It sounds like you need to find yourself a different medical team. Is your oncologist, a medical oncologist or a Genito urinary oncologist? The GU oncologists specialize in prostate cancer and can help you a lot more. Are you working with a center of excellence? Going to a place like that may give you more options.