At 73, I was diagnosed Gleason 7. PSMA PET scan showed three lesions in prostate and likely activity in both iliac lymph nodes. I was prescribed 24 months of ADT (Orgovyx), later reduced to 18, and 44 IMRT treatments, 26 to pelvis generally and 18 to prostate only. Mine has been an exceptional case, experiencing all the side effects on the Orgovyx.com website and developing radiation proctitis even though a SpaceOar gel was inserted prior to radiation as protection. No sex since starting ADT, and I have about six weeks left. Cancer has seemed to have been completely subdued, but life is different when your testosterone is maintained at < 10. You're considerably younger, but your cancer is judged to be aggressive. You might try radiation alone, followed by ADT only as backup. I have a 53 yo friend, though, who had a radical prostectomy. Nerve sparing was successful, and he is doing great with no radiation and no ADT. He's also an exception. Saying a prayer and wishing you well as you choose.