Stage 4. What are Treatment Options when radiation is not possible?

I suspect that Pluvicto is jumping a step or two or three. If I were in your situation. ( and I suspect that I will be within a few months ) I would ask my medical team about a return to ADT and Erleada and perhaps also chemo treatment with docetaxel or something like that. It is my understanding that Pluvicto is given when there are no other reasonable options. Est of luck!

Definitely seek out counsel from your health team, engage in personal research and education, and most of all, breathe and relax because you are not alone and there are long-term viable treatment plans for this chronic condition. Here is an entry point into the topic starting with 1. castrate sensitive hormone treatment (ADT) should be an option to consider, this could keep your PSA low for months, years or even decades with an initial round of treatment and then intermittent therapy. 2. castrate resistant treatment with a wide variety of drugs not limited to PARP inhibitors, androgen receptor signal inhibitors, and more. 3. platinum based chemotherapy such as docetaxel and other targeted drugs. 4. theranostic techniques such as Pluvicto.

Just to fast track to a personal comment about the inquiry about Pluvicto, I'll be 53 this year and will finish 2 years of ADT this fall, and had RALP 12 years ago. When the BCR happened my first choice was "lets solve this with Pluvicto" and while my medical team explained the US protocol to qualify, the more important insight was that the oncologist said "we want you to live for a long time, and science has no idea of the potential harmful effects of nuclear medicine 10 or 20 years or more, after usage". In general, treatment methods that are effective and also have manageable side effects should be your first option. Trust me, ADT sucks, but all things considered, I'm complaining about side effects and the other option would be going to chemotherapy or just sailing off and letting the cancer win, ... and that ain't going to happen on my watch!

keep the faith

@starman, I hope you saw the helpful posts from @edmond1971 and @starman.

Here are related discussions that you may wish to explore:
- Pluvicto https://connect.mayoclinic.org/group/prostate-cancer/?search=Pluvicto%20&index=discussions
- Stage 4 https://connect.mayoclinic.org/group/prostate-cancer/?search=stage%204&index=discussions

Starman, what treatment options have been discussed with your team? Are you currently on androgen deprivation therapy (ADT)?

I am currently on apalutamide 60mgX2tablets and Lupron injections X 3 months

I’m a newbi and my navigation on this site is rather difficult for me as my computer skills are rather basic.How do I get to replies to my post?

Basically continue with ADT(Erleda and Lupron).I’m told radiation is not possible due to the location of lymph nodes.I wonder if Pluvitco may be used.I have only a few nodes that are affected as far as I know.

Thanks I was given the option of taking a drug ‘holiday’ as my psa has been negligible for 2 years now.I don’t want to risk it and decided to stay on ADT and live with the side effects.Dr.Kwon told me that i could be possible ‘cured’ but radiation is not possible due to the anatomic location of my lymph nodes.

Stay on ADT Zolodex too to stop testosterone the fertilizer of PC