My situation was almost identical to you except my PSA was 7.1, clear MRI, two positive biopsy cores 3 +4 = 7 and 4 +3 = 7. I was treated at Emory Winship Cancer center with:

- Bargiel rectal spacer
- 5 weeks daily IMRT radiation
- 6 months Orgovyx ADP pills
- One single High Dose Brachytherapy procedure

Now 12 months post treatment I can say the only ADT issues I had was intermittent fatigue on hot days (lasted only a few minutes), some minor weight gain, and moments of heightened emotions for no particular reason.

I did not notice any muscle or bone loss but I did experience a few days of strange shin pain just after starting the Orgovyx. The pain disappeared a few days later and never reoccurred.

I walked and continue to walk 30 - 40 minutes five days a week. I have heard exercise is key to avoiding ADT side effects.

I have read conflicting reports on the true benefit of ADT with a radiation treatment plan. My RO strongly suggested I take the Orgovyx and said "if I were in your shoes...I would take it...it won't kill you". At the time, he said my chances for a positive outcome would be improved with the ADT for six months.

Thankfully, my PSA stands at .1 and one year later I feel as good as I did prior to being diagnosed and treated. I hope the same for you.