Actually, that's standard of care for metastatic or high-risk prostate cancer these days: take ADT (like Orgovyx or Lupron) and an ARSI (like Nubeqa or Zytiga) together, right from the start. It's often called "doublet therapy."

If the patient has high-load metastatic cancer, toss in chemotherapy, then you have "triplet therapy."

These new ways of using existing treatments all together up front (rather than the old incrementalist approach) have improved our prospects drastically. Additional options for low-load oligometastatic prostate cancer include metastasis-directed therapy (MDT) and prostate-directed radiotherapy (PDRT); for high-load polymetastatic prostate cancer, there are also radioligands like Pluvicto.

The idea these days is to shock and awe metastatic or high-risk prostate cancer at the beginning, rather than attacking it in dribs and drabs, escalating to the next treatment only when the previous one fails.