Decision to continue or discontinue hormone treatments in stage 4.

I do not know the answer to your question. However, ADT is effective for metastatic castrate sensitive prostate cancer, and after it becomes castrate resistant there are additional drugs such as androgen receptor inhibitors and PARP inhibitors. Later down the road options include chemotherapy and then nuclear medicine. While on the journey, new advances may come to be.

I do not like being on ADT, in full disclosure

Hormone treatments + Erleada (Apalutamide) had not yet reached median mortality at 52.2 months in the big TITAN study for metastatic castrate-sensitive prostate cancer (at the beginning, even if it progressed to castrate-resistant later).

Source: https://pubmed.ncbi.nlm.nih.gov/33914595/

I put the treatment into my doctors hands and they have been doing pretty well for the last 10 years. I have been stage 4 metastatic castrate-resistant prostate cancer for 10 years now.

That time span is good to hear. I'm so frightened of the time when my mCSPC eventually turns castrate-resistant, and to hear that you've been going for 10 years with mCRPC lets me hope a little more.

Another thing to remember is that "overall survival" (OS) means the median time to end of life from ANY cause, not just cancer or side-effects from cancer treatments like chemo. In one prostate cancer study I read, the average age of participants was in the mid 70s. While mid 70s is by no means ancient these days (runners that age used to pass me on the jogging path when I was in my 30s), and people are right to expect lots of active, healthy years ahead, many study participants will have passed away from causes other than the prostate-cancer itself during the research period For those of us diagnosed in our 50s or 60s, the median OS numbers are a little tickier to make sense of.

This question really can't be answered without additional information such as stage of cancer, Gleason score, extent of disease etc. My understanding is that hormone therapy is the backbone of treatment for those of us with metastatic disease, although many MO (mine included) are opting for intermittent ADT to preserve quality of life.

yea I have been confused with that anyway . I have a node that has escaped but not gone anywhere , he is always reminding me that is not metastatic " disease'. there are no distant metastatic issues I know of . And it seems that the lupron strategy is giving way to more curative thinking. I hate the hormone on every level . It is unnatural and renders quality of life to the lowest common denominator

I assume you have had a RP and now have a positive node in your pelvis without additional disease elsewhere. It sounds like you are great candidate for targeted radiation (SBRT) to that node with or without shorter hormonal therapy. Good luck.