For a patient with localized high risk prostate cancer with high risk Decipher score receiving ADT and abiraterone, is there any value of continuing ADT and abiraterone beyond two years?

Since the trial (STAMPEDE) stopped abi at 2 years, that is the longest duration that I use.

In the mHSPC setting, we are seeing many patients stay on their first-line treatment for many years (often longer than 2 years). This has made me more cognizant of the long-term effects of abi/prednisone (accelerating sarcopenia, bone loss, and skin thinning). I suggest staying to 2 years.

The other question that I don't understand is the duration of ADT for these men. In the trial, they used ADT for 3 years and abi for 2. That seems unusual to me. I often stop both at 2 years. Not sure that is the correct thing to do. Based on ADT/XRT in the localized disease setting, 2 years seems a reasonable duration of ADT from that data so I feel comfortable stopping early to maximize quality of life. 

I assume you are treating per STAMPEDE platform i.e., N+ or (recently) high risk N0. The trial didn't go past 2 years abi. Toxicity can be substantial and with PSMA PET, I have stopped at 2 years or sooner and conducted vigilant surveillance.