There are some clinical trials that look into newer treatments or combinations of drugs for patients who haven't yet started ADT. I applied for a trial of the PROSVAC vaccine at Dana-Farber a couple of years after my PSA returned following failed SRT. My hope at the time was that the trial might offer an alternative treatment that would delay starting ADT. In the couple of months I was going through the initial screening, PSA rose quickly resulting in a doubling time that disqualified me. FWIW, that was an
open trial -- all patients would get the vaccine, but some would start immediately and others would start after a 6 month delay and patients would know which group they were in. The trial is still ongoing but, per clinicaltrials.gov, is no longer enrolling new patients.
My MO offered a different trial for high-risk BCR patients (defined as having a doubling time of <9 months). This is also an
open trial. Patients know which of the three trial arms they have been randomized into. Given I was now destined to start ADT anyway, I was hoping to get into the trial arm that included standard ADT plus Apalutamide. The trial's goal is to see if using Apalutamide or Apalutamide plus Zytiga in addition to standard ADT in the early stage of recurrence might be beneficial. However, I was randomized into the trial arm that gets standard ADT only. So for all practical purposes I get the same treatment I would be getting otherwise, but have some additional blood tests and Medicare pays the full costs of CT and bone scans, so I have no co-pay for them.
The trial is still enrolling, so I'll link it below. But the thing to consider with this trial is that at minimum you will get standard ADT - either Lupron or Firmgon. Or you could be getting a double or triply whammy of drugs that will likely have additional side effects beyond standard ADT. You'd need to consider if you are willing to risk extra SE's up front in the hope of (by no assurance of) maybe then having a longer time to mets or castrate resistance. https://clinicaltrials.gov/ct2/results?cond=prostate+cancer&term=androgen+annihilation&cntry=&state=&city=&dist=