Input, but not qualified for wisdom.

Were the scans PSMA PET scans? Only to understand if you have certainty that both sites are most probably PCa metastases.

Assuming you have PSMA PET Scan data showing metastases ion those two sites, I am also making an assumption that the scan showed a lesion on bladder as opposed to an area of your body behind the bladder.

I would use the below data to make any treatment decisions based upon estimated quality of life versus time.

I would want to know from the best radiological center that you have access to what options they can offer for each site (pelvis and bladder), precision of the equipment the center can offer (others on this forum can provide you detailed feedback once they tell you the equipment they have), how they would mitigate damage to the bladder, and their assessment of potential complications for you.

Similarly from the genitourinary medical oncologist for ADT options. In particular, potential complications and side effects specifically for you.

Also from the genitourinary medical oncologist, their opinion based upon the information available to them of your specific PCa of time versus expected affects to both pelvis, bladder, and potentially other sites. Ideally, the oncologist has access to the PSA and PET Scan history to understand the rate of growths.

17 years is a long time and depending when your PSA reached 0.20 (BCR), and the doubling rate since, and when the first PET Scan detected growth on the pelvis and bladder, your oncologist can help you understand the affects to your pelvis and separately your bladder.

Hopefully others can give your more helpful input.