@jeffmarc Medical and biological matters are so complex and difficult to predict at first diagnosis that no one can really know what is the "best" treatment plan for any given situation. In your own case, what I am most impressed with is your ability to survive, even thrive, with a long term metastatic condition. For those of us who might ultimately evolve to that situation, you are a great example of how life can still be good and long even with a distant metastatic condition.

What I wonder about in situations like yours when you were first diagnosed and you had the opportunity to either go with surgery or with a comprehensive radiation plan combined with ADT, could the radiation to both the prostate gland and the greater pelvic region kill all the cancer that was present and possibly prevent any future recurrence? Of course, if undetected cancer had already spread further than the pelvic region then that approach would not have worked either. Also, if your cancer was so aggressive and so persistent to live that even high dose radiation with ADT couldn't kill all of it then you would still have had a recurrence leading to eventual distant metastasis.

We can always wonder about all kinds of what ifs after the fact, but for many facing these issues right now they and their doctors have to analyze all the historical statistics and also give some consideration to current anecdotal information to come up with what they believe is the best plan. And there will usually be no obvious best plan.