I had a Gleason score of 4+4; the cancer appeared to be contained in the prostate with no obvious 'puching' of the outer membrane. I chose PBT at Mayo/Rochester. They suggested a short course of 4 months of ADT (Lupron, I think). My understanding was the reason for the ADT was to add to the possibility that injured or damaged prostate cancer cells would not have the 'food' of testosterone.
I had reduced libido, increased ED and perhaps increased emotional lows (hard to distinguish ADT vs the middle of the pandemic).
Since then my PSA has stayed about .02.

ADT certainly has benefits depending on individual diagnoses and circumstances, but I (and others, I believe) might have benefitted with more coaching about the need for muscle strengthening /maintaining exercise and maybe emotional coaching. It was certainly 'different' to have my libido hit zero. Since the ADT shot has worn off, I've had some recovery of libido and ED. Not sure about muscle loss.

Hope that helps.