They usually offer Zytiga as the third drug. If you have heart issues they might not do that.

You said
“ adding a second ADT drug like Erleada, Estradiol or Eligard”

Eligard is just a different version of Lupron.’

The 2nd level drugs ARSI’s are

Zytiga (abiraterone) The one usually picked first. Side effects can be an issue.

Erleada (apalutamide) is one of the three lutamide drugs, The other two are Xtandi (Enzalutamide) and Nubeqa (Darolutamide).

Nubeqa has the least side effects and doesn’t pass the blood brain barrier so it doesn’t cause brain fog like the other ones can. And also has much less fatigue than the other two drugs.

I used abiraterone for 2 1/2 years, it just caused too many issues (Cardiac). I switched to Nubeqa and Couldn’t be more pleased. After 15 years, I’ve been undetectable for 20 months on Nubeqa. On abiraterone I was only undetectable one month in 2 1/2 years.

I know a lot of men of all ages using Nubeqa, many as their only drug.

The estradiol patch has the least side effects, but is not really been FDA approved and doctors are not using it unless pressured, frequently. If you are interested, over at Ancan.org there are videos by Richard Wassersug about using estradiol, He has done it for years.