I had triple therapy at Johns Hopkins a little over a year ago. I was in good health with the exception of the PC. I am 70 yo and had RP in 2021 with single met at T8 6 months later. Had SBRT successfully without additional treatment at that time. Four months later after PSA went up to 4.6 from 0.37 a PSMA PET showed a positive node in my pelvis. Went to JH for systemic treatment in October 2022. Was immediately put on Lupron and within 2 weeks started chemo with Taxotere in addition to androgen receptor blocker Darolutamide. Had 4 cycles (my MO believes that is what was needed, not 6) of Taxotere in 3 months and at that time the Darolutamide was discontinued as well. My PSA became undetectable after 2nd chemo treatment and has remained so for over a year now. Had my last Lupron (3 month) shot in July, so I was on Lupron for 1 year. Eight weeks after the chemo had full pelvic radiation.
As for side effects, I have had significant fatigue since starting the Lupron continuing to now, but my Testosterone hasn't yet recovered. I have had some brain fog and depression, treated successfully with an antidepressant. I have had muscle and joint soreness and stiffness. I lost most of my head hair with the chemo which grew back about 4-6 months later and is actually a little thicker (probably due to low T). I lost most of my body hair. Low libido. Genital shrinkage.
Most of the above side effects are from the Lupron. I did have low WBC count after the 3rd chemo cycle which they treated. No nausea or vomiting.
Of course, the good news is there is currently no sign of the cancer with an undetectable PSA.
I opted for aggressive treatment at Johns Hopkins after I read a journal article titled Total Eradication Therapy. I wanted a chance at a cure or at least a long term remission. Triple therapy in conjunction with my RP and then pelvic radiation made sense to me. The therapy/drug that has given me the most side effects is the Lupron but that is the main line treatment if the cancer has spread outside of the gland.
Hope that helps. I believe getting state-of-the-art treatment at a progressive medical center is the way to go if you have a high grade tumor that has very limited spread (oligo metastatic) outside the prostate. Good luck

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