Not as severe a case, but with BRCA2 I stayed on ADT for 8 years. I only quit ADT because I was on it so long it’s unlikely my testosterone will ever come back much. If it does, I have to go back on ADT. I am on Nubeqa.

I walk at least 2 miles every day on the track and go to the gym three times a week. Never had much of a problem with fatigue And it sure helps when your muscles deteriorate after taking these drugs and your bones weaken as well without doing some weight training.

In 2010 I was 62 and a biopsy showed Gleason 3+4. Had surgery, after surgery they told me it was a 4+3. It was only stage two. 3.5 Years later it came back and I had radiation. 2 1/2 years later it came back and I went on Lupron. I became castrate resistant 2.5 years later and added biclautamide. 1 year later went on Zytiga, which kept my PSA down for 2 1/2 years., After some AFIB Issues I switched over to Nubeqa, The last 18 months I’ve been undetectable. I became stage four about six years ago. I did not find out I was BRCA2 Until four years ago.

I figured that When Nubeqa Stops working I will start taking the PARP, I am concerned about the wbc, RBC and platelets, Which are just some of the things I can have problems with when on a PARP inhibitor.

Depending on your cancer case some doctors want to use a PARP Inhibitor early. Read up on it and you will find some articles that discuss it.

Everyone is different with prostate cancer so I can’t tell you what your best choice is, ask your doctor, hopefully, you are working with the center of excellence that can better guide you on what to do.

I had severe hot flashes for the first year on Lupron. As a hot flash was hitting I would feel a lot of fatigue. After a year, my oncologist prescribed a depo-provera shot every three months and it really stopped those hot flashes on Lupron. There are other hormones that can do this, speak to your doctor. I went on abiraterone 1.5 years later and the hot flashes came back, not as frequent or strong,
I know one person that says eating tofu every day really controlled his hot flashes, another person in this forum said the same thing. Can’t hurt to try it. Black Cohash is also said to help. Acupuncture works for some people.

I have an embrlabs.com wave product (wave 2). I’ve used it for Over three years now. It’s like a refrigerator that looks like a watch and sits on the inside of your wrist. You could set up one of the buttons for their night mode . Hit the button twice and It Produces cold waves at measured times during the night and prevents hot flashes and night sweats. They used to bug me, before I got this device . When you start to feel a hot flash coming on, you hit another one of the buttons twice and it sends cold chills through your arms and it reduces the intensity, shortens the life and can stop the hot flashes if hit quickly enough.
https://embrlabs.com/