The Dr. Michael Schweizer at Fred Hutch recommended by Jeff is conducting research into Transdermal Estradiol, a.k.a. tE2, as an alternate to Lupron and Orgovyx, or any of the drugs you might be prescribed as ADT if the therapy you choose includes ADT. Apparently he can prescribe and monitor patients who take it.

tE2 can be 1/100 to 1/400 cheaper than drugs traditionally prescribed for ADT, and it does not come with the side effects most commonly objected to by patients on ADT. Take a look at the website https://estradiolinitiative.org/

tE2 is becoming increasingly recognized as equivalent in efficacy with less side effects after the recent publication of the highest standard of evidence in one of the best medical journals, i.e. https://www.nejm.org/doi/10.1056/NEJMoa2511781

If the PET scan doesn't show that you are ineligible for radiation or surgery, a radiation treatment you might want to consider is Brachytherapy. In your case this would probably be prescribed as in addition to some sort of external beam, either protons or photons.

Dr. Michael Folkert is the chief of brachytherapy at Fred Hutch. I highly recommend him. When it comes to brachytherapy it is essential to get the treatment from a highly experienced group. This is who Folkert is, and what he leads at Fred Hutch. They have the ability deliver high dose brachytherapy, a.k.a. HDR, which can be used even if the cancer has spread outside the prostate into the seminal vesicles.

Dr. John Sylvester is one of the most experienced brachytherapists in the world. His presentation at a 2024 symposium "Brachytherapy: The Historical Evolution, Techniques, and Efficacy in Prostate Cancer Management" is worth seeing if you do consider brachy.
https://grandroundsinurology.com/brachytherapy-the-historical-evolution-techniques-and-efficacy-in-prostate-cancer-management/
Dr. Nelson Stone is another of the most experienced practitioners of brachy. In his presentation "Radiation Dose and Hormone Therapy: How Much is Enough?" he discusses why shorter periods of ADT are required when brachytherapy is used. Basically, it is not possible to administer the highest possible safe dose of radiation to the prostate unless brachy is used, and the data shows that the higher the dose, the better the outcome of the treatment is.
https://grandroundsinurology.com/radiation-dose-and-hormone-therapy-how-much-is-enough/