I think that sums it up pretty well.

Treat too soon or too late...
Mono, doublet or triplet therapy....
Continuous, intermittent or as I call it, for a defined period, criteria to stop, actively monitor and criteria to start again....
Quality versus quantity....
A very heterogeneous disease both in the cells that are PCa and our own PCa.
Financial toxicity ...
A plethora of treatment decisions that by the very exponential nature of medical research and the prodding nature of PCa for many do not necessarily lend themselves to long term data about overall survival so we use progression free, radiology free and the window for that data is 3-5 years.
The diversity of options the different members of our medical team - urologist, oncologist and radiologist bring to the decision making process.

If there is any good news in this journey it's the explosion of treatment and imaging advances in the last 10 years which may mean most can manage this as a chronic disease.

My case is an example, diagnosed in 2014, surgery, BCR in late 2015, SRT in 2016, triplet therapy in 2017-2018, 4-1/2 years off treatment and now it's back....a Plarify scan shows a single PLN though we know there's more, micro metastatic...I'm sitting with my radiologist reviewing the scan, she's been on my team since 2016, we both talked about not having this conversation in 2016 since no imaging at that time could have seen this lone lymph node. My oncologist and I are talking about whether or not to add an ARI and for how long. I'm taking Orgovyx vice that damn Lupron, side affect profile is so much better...

We know how this journey can end, it's not pretty. So, I'll do what it takes to have a different end to my story.

Kevin