FWIW, I was started on Orgovyx based on biopsy results (Geason 9 - 5+4) and it was started immediately following a PSMA PET scan. Nubequa was added immediately after the PET results showed metastatic lymph and bone involvement 4 days later. I'm new at this fight and just a layman, but I would think that unless testosterone is a confirmed zero, ARI added to ADT is prudent, especially if the disease has spread beyond the prostate.