It sounds like you've had a rough time, and again, I'm sorry. My experiences have been too different from yours to offer much help, but I hope others in the forum might have notes to compare.

The one thing we have in common is spinal metastasis. They had to put rods and cement in my spine from T1–T5 after they gouged out (and later radiated) the lesion there; otherwise, my middle spine would be "mush" as well. I have some mild chronic pain from all that hardware and damage, but eventually learned to cope without pain meds.

You say the plan is Zytiga in January? I’m a little surprised since such a high PSA would really imply that you needed ADT and a second drug like Zytiga right away. Did your PSA rise while on Enz And that’s why he wants to do Zytiga? Unfortunately That seldom works (5% success). If you got off Enzalutamide Before your PSA rose, then it may work to move to Zytiga.

Pluvicto (Lu-177) Is good for removing a number of metastasis from your body. It only works in about 1/3 of people real well 1/3 of people OK and 1/3 of people not at all. Sounds like a good thing to try.

Before doing Pluvicto You should get a somatic test. You need to find out what genetic anomalies might be in your body, Even if you don’t have hereditary problems, they can show up in your blood after having cancer If you have the Genetic problems of PTen or RB1 Then Pluvicto May not work very well. If you have BRCA then it is more effective.