Multi-arm Multi-modality Therapy for Very High Risk Localized and Low Volume Metastatic Prostatic Adenocarcinoma

Inclusion Criteria: * Willing and able to provide written informed consent and Authorization for Use and Release of Health and Research Study Information (HIPAA authorization) NOTE: HIPAA authorization may be either included in the informed consent or obtained separately * Male aged 18 years and above * Serum testosterone of ≥150 ng/dL (For Cohorts A and B1, testosterone level requirement is exempted if they are already on ADT prior to treatment start. For Cohort B2, subjects will be considered eligible if their testosterone is currently ≥150 ng/dl). * Histologically confirmed adenocarcinoma of the prostate, who meet the following criteria: Cohort A * Clinically localized disease with histologically confirmed adenocarcinoma of the prostate with either ≥3 positive cores or 2 positive cores if \>1cm in length with at least 50% tumor content WITH * With Gleason score 8-10 OR * Gleason 4+3 with one of the following features: * PSA ≥ 20 mg/mL within 2 months prior to diagnostic biopsy * MRI suspicious for radiographic ≥T3 disease (if urologist deems tumor is resectable at baseline); defined as \>75% probability of extracapsular extension or seminal vesicle invasion in the opinion of the reading radiologist. OR * Gleason 3+4 or 4+3 and Oncotype DX Genomic Prostate Score of \>40 * With or without clinical N1 (size \>1.5cm in the short axis) (Gleason score requirement can be omitted if node positive) OR Cohort B1 * Newly diagnosed low-volume metastatic disease wit…