Just to add to the conversation a bit more. My MO and his NP have been treating oligo metastatic disease, as I described in my other post, for a number of years now. In fact, a search of the literature is how I discovered them, contacted them by email which led to a Zoom consultation and then treatment in 2022. I read an article by Diane Reyes (his NP) and Ken Pienta ( my MO) titled "Total Eradication Therapy". It was a smaller series of men treated with RP/radiation of the primary, triple therapy, MDT with radiation to the few mets and pelvic radiation. This was in the initial castrate sensitive state. The ADT (Lupron) was discontinued after one year in patients with an undetectable PSA. The majority had their T return to normal levels while maintaining an undetectable PSA off all medication. I remain undetectable after completing triple therapy in 12/22 and last 3 month Lupron injection in 7/23. My T has yet to return to normal, although they say this can take a year after the effects of the ADT wear off.

You are right that this aggressive treatment is still controversial, but hitting the cancer hard in the beginning and killing as many clones and cells as possible made sense to me.

Dr. Pienta is the Director of the Johns Hopkins Brady Urologic Research Institute and holds appointments in the Departments of Urology, Medical Oncology and Molecular Biology. He has published > 300 peer reviewed articles on prostate research, diagnosis and treatment. I have total confidence in both him and Diane Reyes. I will do as they suggest. I have read on many forums patients that read literature and try to direct their own treatment to some degree. That doesn't work for me. I know just enough to be dangerous having practiced medicine for 40 years but also know enough to realize my specialists know much more than me.

Each person needs to find their own path and I wish everyone the best.