My understanding is that those of us who are metastatic with bone metastases only have Radium 223 and Pluvicto (Lu 177) as radiological treatments. The thing that most people do not understand is that Radium 223 cannot be followed after receiving LU 177. But you can get Pluvicto after receiving Radium 223. I confirmed this with my oncology team but I still do not understand it. So, for me, I'm going Radium 223 first and if that fails down the road I would then consider Chemo and or LU 177. For now, I am castrate / hormone sensitive and these options would be considered in the distant future if ever. I'm still expecting the quadruplet therapy I received (i.e., radiation, ADT, Nubeqa (Darolutamide), and 10 rounds of chemo) to continue working. The other thing I read that should be considered if your PSA starts rising and you need another treatment is now required is to request another Genomic blood test to see if there are any new mutations that can be acted on with Immunotherapy. I heard that is a Eugene Kwon video recently. Made me happy. Keep fighting.