Forgot to mention: 72 year old male in otherwise excellent health.
And it is SYMPTOMS..not systems...
Medicare Advantage covering almost all costs, too

Well, I am not an oncologist, but I am a patient looking at biochemical relapse after surgery 4 years out. I know I will need about 40 treatments buy they haven't told me yet about how long the duration of hormones would be. From what I've heard, they are NOT fun nor are they good for you, but they do tamp down the disease.
However, it DOES seem like a long time to be on hormones in your case. I could see continuing for maybe 3-6 months after radiation, but more than that?? It seems like overkill to me at this point and I would definitely get a second - and even a third - opinion. There is no "one size fits all" for this disease so you may have other factors that are being considered. If two other oncologist agree with your first one, well that's pretty much it. But I really think you will get a wide diversion of opinions here. Best of luck and please let us all know what you decide.
AL

https://ascopost.com/videos/2021-astro-annual-meeting/amar-kishan-on-prostate-cancer-impact-of-androgen-deprivation-therapy-with-radiotherapy/
It has to be the 40PSA informing your prescribed treatment. But research seems to be showing that the hormone blocks prevent recurrence and metastasis even in low risk patient. You have to balance that for yourself. Are you willing to take whatever risk of recurrence in order to be comfortable and feel healthy now. I suspect I would take the risk and deal with whatever recurrence. Respecting that the oncologists' goal is to rid the system of cancer.

How old are you. It makes a difference.

Well, the PSA of 40 may be why they are doing triplet therapy based on what you describe...intermediate high risk.

Even with your scans,that PSA may have micro-metastatic disease, too small to be seen with even today's most sensitive PCa imaging.

The questions is, how long "should" your ADT be...!?

Not sure you'll find a consensus, either on this forum or in your literature research. I can say this, six months may be too short, 36 months too long, anyon saying lifetime, no...

Most will say 18-24 months. In my case, when we did triplet therapy in Jan 17, the plan was 24 months. Based on my response, PSA dropped to undetectable quickly and stayed there, Dr. Kwon agreed to 18 months. That brought me 4-1/2 years off treatment, no cure though, What would 24 months have brought, we'll never know since I am a study of one and we can't clone me and compare the two! My PCa is not "curable," or at least that's mainstream thought. It is manageable, particularly since it has not spread to the bones or organs. Yours may be, a question you may want to ask yourself and your medical team...is this a shot at a cure, if so, will the 24 months versus 6, 12, 18 better achieve that outcome? There are no guarantees though..

On this go around, my local oncologist in concert with my radiologist are recommended 12 months in combination with SBRT. They felt six months was too short, 24 months too long based on my clinical history and current clinical data from labs and Plarify scan.

A starting point for discussions with your medical team may be the NCCN Guidelines, this link may get you started - https://jnccn360.org/prostate/for-your-patients/nccn-guidelines-for-patients-prostate-cancer-advanced-stage/ These guidelines are a starting point for the standard of care in treatment of various stages of PCa.

Kevin