Kbota this is an interesting crossroad in PCa in general, in the past surgery was not a combined protocol with hormone drugs or PCa drugs. Your numbers are high risk which you know by looking at nomograms, high risk for being curative directly from surgery. One guy not long ago posted on P2P to Dr. Strum about his 13 yrs. of clear sailing with surgery only, then had slight psa increases and worry, and started a therapy thereafter, he also was a Gleason 9 patient. This is just fyi-doesn't mean the same would be your situation, we just don't know. There are cases of psa failure in short durations, also.
Here is another school of thought and they have abstracts to support their thinking:
Basically the it makes no difference which drug protocols you take, people live the same time span, is their message (thus they didn't look,ones whom have cases that defied the odds). How that is totally objectively measured is beyond logic to me.
Dr. Fred Lee is the greatest example I have ever witnessed Dx 27 yrs. ago and treated for PCa, failed cure 25 yrs. ago, went onto emcyt drug (most docs would never prescribe it), he has been on this well over a decade and still alive at age 80. There are others, but not this dramatic to witness, but can see have lived alot longer having done additional maybe controversial or weird protocols. Good whom doesn't want to be weird and live perhaps longer or be the anectdotal patient(s) that the abstracts seem to careless about or consider it less noteworthy. (Dr. Lee is anectdotal in results, not cured...that is my point I guess)
Back to your choices, I don't wish to influence your choice, it is yours...questioning it all and looking at your total choices would be a good idea, this is a one time choice right now.
Maybe find out is your doc biased if you say I want Zoladex (it usually is less profittable) or why not go on Degarelix (newly approved this year)-it has no 'Flare up' issues like LHRH drugs and is very comparable otherwise. Why not use emcyt, DES, estradiol or other drugs in this concept of drugs now? (LOL) I know those will be shot down, but actually they cause direct apoptosis on PCa and have less overall side effects(this can be argued so let's forget the idea)....I know the arguments seen them for years...those drugs would not ever be mentioned and especially not in the urologists vocabulary, are in onco-docs vocabulary.
Ok so you do as this doctors says, do you take casodex prior to prevent flare? ask him now. Now Dr. C. a uro-doc recently said it makes no difference basically in using casodex prior to prevent flare(unless known mets perhaps) also doesn't believe ADT3 is worthy(fyi), well micro mets goes undetectable and Dr. Strum whom is miles above this doctors knowledge on overall PCa, says 'No patient should be subjected to Flare'. I prefer the wisdom of this doctor, you don't have to agree...this is PCa...some of the docs don't agree on plenty.
I would avoid flare like the plague if it were my decision and knew of such, you just had surgery and you wish to feed PCa 'T' in the intial Flare up on LHRH which can be for a few weeks before it drops your 'T' levels and goes to real work???? Maybe ask this doc a few interesting questions so maybe you will know his thoughts. One of our brothers herein just had a bout with a flare issue it appears and was not a pleasant thing to have, doesn't mean it will ruin you either, but is unnecessary and known to be unhelpful. Dr. Strum had an example of a patient whom died in complications from Flare issue (proves his point well).
On the pluses side of LHRH now, it will mask your psa and look like a cure scenario(we all like those numbers), be anectdotal cure or in results duration, perhaps in so doing (would be a new one for the books), the doc makes alot of additional money on your case (his pluses).
You sacrifice 2 yrs. of side effects but actually do have much longer clear duration which might happen, of course remember the other docs whom believe the it makes no real difference theory...I didn't listen to their theory myself, seems to be good for me. Good hunting and tally ho.
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35 normal, ct and bone scans appearing clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off for 1 yr., controlled so well, resumed, using intermittently, pleased with results