So, I'm going to disagree with you...

My PCa has metastasized, the C11 Choline scan in January at Mayo showed four PLNs, one pretty high up. My medical team said it was likely not far off from spreading to the bones and organs. We chose triplet therapy, the treatment plan was for 24 months of ADT.

Based on literature search about duration of ADT, data was emerging that 18 months may be about right, better than 6 and 36. I asked my medical team about it, they said given my response to treatment, they were ok with stopping at 18 and actively monitor.

We, myself and my medical team had decision criteria for stopping, actively monitoring while off treatment, labs and consult every 2-4 months, three or more consecutive PSA increases, PSA .5-1.0 and image with a Plarify scan...

That decision criteria was met in March 2023, so, 4-1/2 years off treatment. WHile the goal of triplet therapy was a "cure," I think we all knew, the goal was a durable remission. It's no different this time, we have decision criteria for stopping ADT at 12 months, actively monitoring, resuming treatment.

A literature search of IADT will not bring a definitive answer. Most say is not inferior in terms of overall survival and may improve QOL (well, duh!).

So, my answer was to a specific individual's post, his clinical data, de novo, GS, imaging results and triplet therapy. In his case, he may not want lifetime ADT. I did say read the NCCN guidelines and discuss with his medical team. Here's my take on the NCCN guidelines, they are the science but not the art of diagnosis and treatment. They are population based and based on historical data. Toi be fair, when my insurance denied one of my four C11 Choline scans at Mayo, I cited the NCCN guidelines and won, the science! Of course, the reverse can be true, not in the NCCN guidelines, insurance company can often successfully say no! Given the revolutionary changes in imaging and treatment combined with the heterogeneity, not homogeneity of this darn disease, well, we have choices. lots of them, a dizzying aea, choosing is part science, part art. In his case, the SEs are impacting his QOL to a point where he wants to explore his options. As an example, the EMBARK trial where individuals on Xtandi as a mono-therapy could be a consideration to discuss with his medical team

Another reason not to be on continuous ADT is the adaptation of our PCa, driving resistance. There are others, some many experience deep depression, the fatigue is too much and interferes with being able to function reasonably, the financial burden to some...

That being said, there are reasons to be on continuous ADT, I did not say that in a general context. I am not a medical person who has had training, education and is licensed to practice, there are few if any on these forums who are. That is understood, fellow layman, sharing our experience and passing along information such as NCCN guidelines...

Kevin