If I understand the video I watched from a Mayo oncologist correctly, for mCSPC, in addition to treating the prostate itself (radiation or surgery) and starting on ADT and an ARSI, there are two different paths for a proactive treatment:

1. Many metastases: use chemotherapy to attack the cancer preemptively.

2. Few metastases ("oligometastatic"): apply separate radiation therapy to each of the metastases.

I had just one (large) metastasis to my spine in 2021, so at my cancer centre in Canada we took the second approach after debulking surgery to remove most of the lesion. Now it's 2024, and so far, so good.

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Notes:

mCSPC: metastatic castrate-sensitive prostate cancer (still responding to ADT)

ADT: androgen-deprivation therapy (e.g. Firmagon)

ARSI: androgen-reception signal inhibitor (e.g. Erleada)