Well, a GS 9 puts you in high risk, ergo, your treatment decisions may need to reflect that.

Of course, treatment decisions have to balance other clinical factors, age, health, aka, any existing -co-morbidities and personal preferences.

Systemic therapy in your case can run the gamut from 6-36 months. On the higher end of the risk scale, 24-36 generally.

So, what to do?

You could start with a decision that says:
Radiation - ok
Systemic therapy - ok, but...Orgovyx and say Nubeqa, let's do 24 months and at that point, look at the clinical data and decide whether to continue to 36 or discontinue and actively monitor.

You could also discuss de-intensification criteria with your medical team. There is some data pointing to "rapid responders," those whose PSA drops to "undetectable in the first six months or so, coming off treatment and actively monitoring. (EMBARK Clinical Trial) The difference in PFS and RPFS may be "smaller" than doing the full Monty but there's a tradeoff, depending on T recovery, you may trade a lesser PFS for a "better" life.

If you decide to do systemic therapy, yes, the side effects are well known. The question is, which ones will you experience and their severity?

Well, you won't know until you try. I never lost my libido (to my wife's dismay), the statistics say 80% of men do...nor did I experience depression.

There are "mitigating" strategies which you control:
Diet
Exercise
Managing Stress
Attitude.

As others have indicated in their posts, many go on with their lives while on systemic therapy. Nobody likes the side effects, hot flashes, fatigue, muscle and joint stiffness...but you can live with them.

If the hot flashes become too much to handle, make your medical team do something, they have ways and means to do so. Same for bone density, depression...

Will your T recover if, when you come off treatment? A lot depends on age, baseline T, which systemic therapy...again, you won't know until...

I've done triplet and doublet therapy. Both times we have done "less than" the NCCN guidelines. Those decision were based on the clinical data, rapid response, with actively monitoring after. My T recovered to 100+ in the first three months, 400+ around six months. While on treatment, nothing much changed in what I did, just how I felt doing it.

Kevin