It seems the consensus is to either use MDT which can push back the need for systemic therapy or...use short term systemic therapy in combination with MDT.

What is "short term...?" That can be anywhere from 6-36 months though six seems a reasonable choice in this case.

If you and your medical team choose the MDT + systemic therapy then you'll need to decide which drug, Lupron, Orgovyx...the latter has advantages over the former:
No flare
Faster castration
Higher sustained castration while on it
Faster T recovery when stopping
Lower CV side effect profile

Same side effects though, hot flashes, fatigue, muscle and joint stiffness, genitalia shrinkage...

There is some literature that says those SEs may be "less severe..."

Having done both I'm going to say I don't notice a difference.

There is a third option,, do nothing...this presentation, length, discusses an intriguing point...with advances in imaging, are we treating sooner just because we can see earlier? Does it change the eventual outcome, OS or just PFS and RPFS while subjecting us to the toxicities of treatment.

That answer may lie in one's clinical data, high risk, intermediate, low, age and life expectancy ...? I'm pretty high risk so I treat sooner rather than later. Still, over time I've seen people and their medical teams wait to treat until PSA hit 2, 8, 10...

I can see the logic in the discussion being a 12 year member of this club and back in the day, a CT was useless under a PSA of 20 or so, thus treatment was based mainly on PSA.
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Still, doing nothing is hard to do in the face of clinical data that says something is going on.

When my PCa came back after a five year vacation from triplet therapy, there was a single lymph node identified in a PSMA scan.

MDT was an option but given my clinical history, high risk, I knew there was micro metastatic disease too small to be seen so opted to include 12 months systemic therapy, Orgovyx.

I am two years out from completing that, PSA stable at .03, next labs in July.

Would the outcome have been different if I had done MDT, or as my oncologist wanted, 24 months + an ARI...well never know, we made a decision, no take backs as they say!

My point is you have multiple choices, any of which is likely a good decision

Kevin