Given the high-risk clinical data you describe, somewhat surprised your medical team may not have discussed triplet therapy. The guidelines, such as NCCN and AUA indicate its use. There may be other factors, insurance as you have seen, health of the individual, personal preferences...

There is nothing "wrong" with doublet therapy.

One of the clinical data you may want to discuss with your medical team is how fast the PSA drops on treatment. If it drops to < .2 in the first three to six months, that is an indicator of "success" and a longer PFS period. If it does not, then maybe a discussion with his medical team about chemotherapy.

My experience, albeit exactly that, "my" and "experience" is that advanced PCa is unlikely to be "curable" at this point in medical research. It can be "managed." High risk cancer, like mine, may require aggressive approaches in treatment. That is a discussion with one's medical team.

I am 11+ years into my journey. Each time I have gone on treatment, I have weighed my decisions in concert with my medical team using the science, guidelines and the art, data from clinical trials finding its way into mainstream clinical practice.

When I was not aggressive enough as with SRT only vice adding short term ADT and WPLN radiation, the results were less than optimal. When I was aggressive, doing triplet therapy, the results were more to my liking.

As they say, my body, my choice...I would consider discussing all options, have a multi-disciplinary team, start with the guidelines, then review pertinent clinical trials, and decide.

Kevin