Actually, radiation is the first treatment for a large number of prostate cancer cases. They may put someone on ADT first, to try to shrink the prostate, so that the radiation is more effective. I know dozens of men who’ve had radiation first.

Most patients are offered radiation or surgery, and both result in similar long-term outcomes. There are some exceptions where surgery makes more sense to start with, but in a huge number of cases, radiation is sufficient to remove the cancer.

Doublet therapy is almost never the first step. It is only used in advanced cases where the cancer has already metastasized. The majority of people with prostate cancer have not reached that point yet, so double therapy is not used.

15 years ago when my prostate cancer was found, I had surgery because my father had radiation and still died from it. 3 1/2 years later, I had to have radiation because it came back. Only at that point was I put on ADT for six months, Two months before the actual radiation.

2 1/2 years later, it came back and I went on ADT (Lupron). 2 1/2 years later when I became castrate resistant, I finally went on doublet therapy (Zytiga)..

The vast majority of people only get double therapy after they have a reoccurrence.