@copyman Yes, prostate cancer that hits in your 40s or 50s, like the original poster's, is more likely to be aggressive and fast-moving, and many cases are already advanced on first diagnosis.

In my case, I was diagnosed with de-novo stage 4 oligometastatic prostate cancer in 2021 at age 56. There is no research yet demonstrating that it's safe for me to go off ADT with metastatic prostate cancer (exactly the opposite so far), but the LIBERTAS trial currently underway is testing whether, with the advent of second-generation ARSIs (the -lutamides), it might be possible for exceptional responders with mCSPC to drop the ADT and continue with just Apalutamide. Preliminary results should be due out in a few months.

I'll be watching closely, but when my current regime of Orgovyx+Apalutamide is keeping my PSA undetectable and produces no intolerable side-effects, the stakes are very high for making a change. It's like a cliff-hanger in old movies or TV shows, with the car balanced half over the edge of a cliff: do I really want to try shifting around?