So much missing information. While you do, tell us what your Gleason score is, you don’t give us any other information about yourself Or your biopsy. How old you are is a critical issue in how you are treated when you have prostate cancer,, we have no idea how old you are.

You are right it would not be a standard of care to only go with ADT and/or an ARSI, But if you are 88 years old, Then the likelihood of your cancer coming back and getting worse is pretty low and the pills or shots will take care of it for quite a long time. In your case, if they were giving you only Darolutamide And you are in your late 80s, It might be a gift to you to not give you ADT, to see if the other drug will work alone. ADT will give you many more side effects, So that could be a good choice.

If you can go on the drugs in your PSA drops to undetectable, then that may be all you need if you are in your late 80’s.