Well...

Your radiologist is not wrong.

Is your urologist right? I am not sure.

Generally, lower risk cases may do six months ADT when combining with radiation.

The length of systemic therapy can range from 6-36 months if doing fur a defined period.

In the Embark trial if men achieved undetectable in thirst seven months they came off treatment and actively monitored.

I believe in the SPORT trial systemic therapy was six months.

My radiologist says in the tumor review boards the oncologists are all over the map in which ADT, whether to include an ARI, when, what, for how long, criteria for their recommendation on duration, criteria for coming off treatment...

As you can see from the responses on this forum, there is no single course of action that dominates the thread.

When I did triplet therapy starting in Jan 17, original plan was 24?months. Dr. Kwon discussed adding an ARI but wanted to wait to see how I responded to the Lupron and Taxotere. Based on my response he decided to hold on the ARI. He also supported stopping Lupron at 18 months.

When I did doublet therapy in April 24 my going in position was SBRT and six months Orgovyx. My radiologist supported that. My oncologist was ok with the SBRT but wanted to do 24 months ADT + ARI.

He was citing the EMBARK trial, I was thinking the SPORT trial.

So, we decided on the SBRT, 12 months of Orgovyx, hold the ARI, add only if PSA did not drop to undetectable in the first three months and decide at 12 months whether to come off treatment or continue.

We met at 12 months and agreed to come off treatment.

Would having done 24 months in either situation made a difference in the progression free survival time? We'll never know will we!

What we do know is T recovered, the side effects went away, I fret pretty damn good....as an example, when I started doublet therapy my weight was 191, it climbed to 209. Today I am at 185.

Some have issues with financial toxicity associated with their treatment. Others really do feel like crap and the side effects impacts their lives. Some, well, probably a lot, are trying to push back the onset of castrate resistance.

What would I do were I you, knowing what I know now after 12 years of this?

I would listen to the rationale my urologist has.

I would see if there was middle ground where you could meet the urologist part of the way and then decide at that point.

I would discuss what clinical data would constitute reasons to add an ARI or to come off treatment.

As I said, there may not be a single, definitive, "right" decision. There are good choices...

Kevin