I told my doctor I wanted curative treatment not palliative when I was first diagnosed. Regardless, of my position, I still received the standard of care. But, I received (so called) palliative radiation treatment to my spin and ribs because I had such terrible bone pain at the start. Well, I read that most palliative radiation treatment cycles require only 1 to 2 treatments. I got 10 to the spin and the radiologist messed up and because I was supposed to radiation to my ribs at the same time. So, after finally getting insurance to agree and an apology, I went back and had 5 additional radiation treatments to my ribs. I read in some cases up to 10 palliative radiation treatments can significantly shrink and kill the prostate cancer tumors. You factor in the overlap of radiation to the ribs and I think it successfully killed most of the cancer. So, in a way I received curative radiation treatment. I bolstered the radiation with 10 chemo cycles in hopes to just kill all micro metastases. So, depending on our strength and ability to endure treatments it is possible to get more of a curative approach. Where that fails is when I ask for additional treatment to (clean up) any lingering micro metastases. Doctor said "No". Said there is no efficacy which means they cannot prove it medically helps. To be clear, I wanted just 1 round of radium 223 to clean up any lingering micro metastases that may have been left behind in my bones (if any). But, insurance will not cover Radium 223 unless you are Castrate Resistant and fail other treatments first.

So, if upfront treatment is what is needed to increase overall survival, then why not just try and kill it all up front and maximize overall survival and delay Castrate Resistance? But that is me.

I think at some point we may be able to have more choices in the Castrate Sensitive stages to ensure longer Overall Survival. It appears that many Castrate Resistance treatments are being shifted to Castrate Sensitive (i.e., Darolutamide and Xandi).

I will leave with this bit of information my wife recently shared with me regarding Overall Survival. The reason the data has not really changes much regarding overall survival rates for stage 4 prostate cancer is that we are living much longer and it may take a decade to collect enough information to change those stats. That is good news.

I believe with triplet therapy men are staying Castrate Sensitive much longer (keep in mind that some men do not become Resistant) and there is a higher percentage of men living with this disease past the 10 year mark.

So, nobody can give you a clear answer because we are all different and they really do not have all the updated data at this point. I wake every morning and the first words out of my mouth are "Thank you Lord for one more day, thank you for this day". I go to bed every night and the first words out of my mouth before falling asleep are "Thank you Lord for one more day, thank you for this day".