@denis76 Diagnosed g7 in 2011. 5% of one core in an 8 core biopsy. Psa at the time was about .3. Did AS for 15 years. Psa went up very slowly, until it started to climb rapidly in 2024-2025. Psa hit 6 and a biopsy confirmed g8 in one small tumor about 1cm square. Localized disease, all in prostate, confirmed as much as possible with a psma scan. Since I also had low volume G6 in the other side of prostate, the provider wanted to radiate the whole gland and recommended adt for 6-18 months. (I didn’t want to go through surgery at 73 years of age). After 5 months of Firmagon my psa was less than .02, or undetectable. Testosterone also was almost nonexistent. I also have cardiovascular disease, osteoporosis, and a family history of dementia, so I decided that the risk/benefit profile to continue any longer on the adt was not best for me. Without the other health risks, and a younger age, I may have went longer.

Since the advent of psma scans, recurrent disease is a little more easier to detect and manage. Hope this helps. You can pm me if you want a phone number.

@denis76 I don't think it's still the consensus is that ADT *causes* castrate-resistance — the AR-V7 mutation that helps prostate-cancer cells function without testosterone may already be present in some of them even before you start treatment — but there are other good reasons to take ADT vacations (under your oncologist's guidance) if your PSA is low and your cancer is still early stage. Taking pauses from ADT doesn't defer castrate resistance, but it does reduce your risk of bone-density loss, heart disease, type 2 diabetes, etc.