The answer to this depends On how long you’re going to be on ADT and how serious your case is. I was just working with a guy who’s Gleason nine, but has no other aggressive issues. Two groups of very knowledgeable people has said that he did not need an ARPI because his cancer wasn’t aggressive enough. He was only a T1c. He would only be on ADT for two years because of the Gleason nine. In that timeframe, it’s unlikely for him to become gastric resistant.

So where does your case stand up against that? ADT alone (Orgovyx) may be all you need. Nubeqa Is great, but you could hold it off until later, These drugs only last so long before you become resistant.