I somewhat rushed to surgery on mine because a friend of mine was taking Test. suppression drug for high PSA. Lupron I think. Prostate cancer and its ED side effect is bad enough but then take any male hormone out as well. They even talk about castration. Made me wonder what would be left if your a healthy 68 yr old with no issues. I tried to separate my male ego out of the equation but I am male. I had one out of 12 samples nothing in the margins and 1.2 PSA. One overriding factor for me was maybe I could get it all with no other treatments. I also did a lot of research on whether Test reduction really helped. I had LARP surgery and ended up with ED. But my Test is healthy. I still enjoy the thought of a sexual encounter. My energy is good. Just wondering since the comment came up.

So if I understand correctly, you were on androgen-deprivation therapy (ADT) for 3½ years, then your oncologist had you stop it, and only then your PSA started rising? And once it rose, your oncologist put you on Abiraterone (Zytiga) and Prednisone to try to bring it down again, but it's not working?

I'm beyond personal experience here, and maybe others can help more, but definitely talk to your team about newer treatment strategies. Zytiga is neither ADT nor ARSI but a biosynthesis inhibitor for castrate-resistant PCa (as far as I understand from a quick Google), so you might be able to combine it with Erleada or Xtandi to improve its effectiveness — again, these are just questions to ask your doctor, not informed answers.

I see you have tried abiraterone. Based on what I've learnt, Lu177 (Pluvicto) may be promising if all of your metastases show uptake on PSMA PET. Others include docetaxel or enzalutamide (or another 2nd generation antiandrogen). If feasible, consider getting a gene mutation test to guide future treatments. If you're not yet receiving care at a major cancer center, it might be time to consider that as treatment becomes more specialized after the first/second line therapies. Good luck!