I’ve read through your (& some others’) comments on this thread. But, I’ll respond to each of yours separately —>

(Background: At 65y, for a localized, Gleason 7(4+3), PSA 7.976, I had 28 fractions of proton radiation (2.5 grays per fraction during April-May 2021), with 6 months (two 3-month injections) of Eligard. So, our numbers are similar.)

I had discussions with my urologist (a surgeon), focal therapists (cryo, HIFU, & laser ablation), SBRT (Cyberknife & TruBeam), brachytherapy (LDR & HDR), as well as IMRT (photon) and proton. Each specialist indicated that their protocols would successfully treat my disease. I chose proton; the deciding factor for me was proton’s Bragg-Peak characteristics. I had treatments at the University of Cincinnati, just a 40-minute highway drive from my home.

There are two recent clinical trials comparing proton with photon for prostate cancer treatments - COMPPARE (comparing effectiveness, side effects, and patient-reported quality of life) and PARTIQoL (comparing quality of life and tumor control). Both studies indicated similar tumor control rates and patient-reported quality of life (QOL) outcomes. (Why proton radiation is generally considered superior for treating other solid tumor cancers located near critical, sensitive structures due to its precise targeting and reduced entry, scatter, and exit doses, leading to fewer side effects, but (for some reason) not prostate cancer, I don’t know. That goes into a much deeper discussion about clinical trials.)

The ArteraAI prostate test was not FDA-approved until mid-2025 so, I did not have access to that test. Also, Orgovyx (Religolix) was not FDA-approved for prostate cancer until late-2020 so, I did not have access to that ADT either.

As for an ArteraAI result of “not likely to benefit from hormone therapy”, I would probably take it anyway. The downside of 4-6 months of ADT is minimal, and I would tend to “slightly” overtreat the disease than undertreat it and (possibly) have to come back at it a second time.

There are fairly simple ways to minimize most ADT side-effects, so I wouldn’t let the “don't want to deal with ADT side effects” impact that decision. You also followed that comment with “…in addition to the many others I will endure.” What other side-effects do you think you’ll be enduring?

Prior to starting my six months of ADT hormone therapy, my medical oncologist thoroughly explained both the physical and mental health adverse side-effects of hormone therapy and how to avoid/minimize them —> with resistance training exercises.
> physical: weight-bearing exercises that maintain lean muscle mass helps offset the physical side-effects.
> mental: exercise turns on many “switches” in parts of the brain that put us in a better mood. It reduces stress, anxiety, depression, catastrophizing, and more.

She advised me that incorporating resistance-training exercise was a necessary part of the routine to minimize the potential physical/mental side-effects of hormone therapy.

Except for having zero libido due to the low testosterone, everything still worked. From what I was told by my medical oncologist, the key is to continue doing it, despite the “want to” not being there. Perhaps due to ramping up my resistance-training and cardio exercise programs to minimize the side-effects of hormone therapy, that might(?) also have had the side-benefit of keeping the blood flowing “down there” as well; I don’t know. Much of what goes on “down there” is about hydraulics so, keeping the blood flowing would seem to be important.

Ultimately (of course), the decision is yours.