(With a localized, PSA of 7.976, Grade Group 3 (Gleason 7=4+3), I had 28 sessions of proton radiation + SpaceOAR Vue + 6 months of Eligard.)

The general rule of thumb is that side-effects of ADT will subside at the end of the prescribed number of months + 50% more months. (In my case totaling 9 months; that was easy to deal with.) Note that most side-effects of ADT can be minimized/avoided with resistance-training exercise.

I generally take these things step-by-step —>
With a Grade Group 2 (Gleason Score 3+4) NCCN guidelines do not call for hormone therapy (ADT). (See attached NCCN guideline chart for favorable intermediate risk group prostate cancer.)

However, if it were me and I had any other risks beyond just a vanilla Grade Group 2, I would bump that treatment up a notch due to the PNI - just out of caution.

Also, with a PSA that spikes above 10 sometimes, that would be another increased marker that would lead me to bump up the treatment regimen slightly.

And, with the 0.81 Decipher score, that would be another increased marker that would lean me towards bumping up the treatment regimen slightly.

Regarding the PSMA PET scan results, what were the SUVmax scores?

Bottom-line:
> with a vanilla GG2, if it were me I might side with the urologist.
> but, considering the increased risk factors (markers), if it were me I would side with the RO.

But, I’m a more precautionary type. Weighing the potential benefits against the quality of life concerns, 6 months of ADT (with a robust resistance-training program) would be an easy decision for me to take the ADT.

(Do you have any cardiovascular concerns)?