Ah yes, the conundrum, given the clinical data, what to do...!?

What do you know, well, GS, GG, you can calculate PSADT, PSAV, Cribriform, IDC..

There are other pieces of the puzzle which may aid in making a decision, Genetic Testing, Imaging...

You may be looking at two choices, doublet or triplet therapy.

Most think of triplet therapy as ADT+ARI+Chemotherapy. The literature I've seen about chemotherapy points to of use more in high versus low volume PCa.

The third part of triplet therapy could be radiation, ergo imaging may be useful
In informing that decision.

You'll have other decisions about treatment, which ADT agent, which ARI, how long, 6-36 months, given your clinical data, on the right side of those numbers.

I'm going to disagree with @jeffmarc about "you shouldn't be seeing Kwon.." we should not ever be telling you what to do or not to do or who to see or not see. We can discuss our experiences, share the knowledge we have gained, point you to articles to read that may be relevant to your decision making...

There are a myriad of choices besides doublet and triplet, ARI monotherapy, Estrogen as in the PATCH trial, heck, there are trials showing "success" bringing LU177 forward in the HSPCa space.

It would be great if there could be consensus on what you should do. As the answer from this forum show and you will find from discussing with various medical specialists, the only consensus you may find is, you need treatment...!

I'll close with what would I do if it were I!?

I would do the triplet therapy, yes chemotherapy. My ADT would be Orgovyx, my ARI would be Nubequa, I would include radiation based on imaging, that would include not just the sites identified in the scan but the entire PLN system.

As to the side effects of radiation, well, 69 treatments, SRT, WPLN, SBRT, 155 Gya, side effects, none. Then again, I've got a pretty good radiologist. My wife agrees but says being a cantankerous sort plays a role.

My starting duration for systemic therapy would be 36 months and adjust, de- intensify, based on my response to treatment.

That's me though, I am not you.

As an aside, I did triplet therapy in 2017 after consultation with Dr. Kwon. We didn't use an ARI though but radiated the entire PLN system with boosts and wider margins to the locations identified in the C11 Choline scan. That brought a five year remission.

Kevin