The waiting is terrible

Your husband might be a good case for Pluvicto before anything else. That can greatly reduce the tumors all over the body. The problem is it only works real well with 1/3 of people and OK with 1/3 of people, the other third it doesn’t work at all.

The normal option for him would be ADT plus a second drug (Zytiga or a lutamide) and chemotherapy. That would shrink the tumors and then chemo would kill them. They probably would do this before or after Pluvicto.

They used to do chemo before Pluvicto, But doctors are changing their minds about the issue.

These are issues you can talk to your doctor About, but you really should get a second opinion from a high end medical institution.

Are you at a center of excellence for treatment?

Are you working with a Genito urinary oncologist, The ones that specialize in prostate cancer? Medical oncologist do not specialize in prostate cancer. They work with all different types of cancers.

With the right treatment, your husband may live many more years.

I am stage 4, my cancer had spread to my pelvis and one lymph node. I had very few symptoms prior. My PSA was 62 when I was diagnosed. After the PSMA PET scan, my urologist immediately put me in ADT drugs. This was last September, my PSA has dropped to .2 now. These drugs essentially stop the cancer, at least for a year or 2. Or until other treatments.

We're going to see a urology something oncologist at UNC on the 17th... He came highly recommended.
I'm tempted to try DUKE or Mayo here, but want to at least talk to ONE person first!
We really feel like it's so wide spread, I don't know if they'll even have an answer or just deal with symptoms.....

What were your side effects of it?
My husband is afraid of the hot flashes and mood swings and all the other stuff that can happen.... I told him- HA welcome to a woman's world in mid 40s.....
And that I'd rather have a husband and no sex life, than a dead husband (and still no sex life)
I'm surprised that UNC didn't jump all over us and started something right away for him, instead we have to wait 10 days from the PET scan.
We just want answers if there's hope or not, so far google and forums like this are pretty dire and I haven't come across anything that's as bad as his.
Yet the symptoms are minimal!

Praying for the entire family I know how it effects many, I agree with the waiting part. What is urgent to us when we hear the words cancer, is not so urgent to the care team. They told me the cancer in me had been growing for quite a long time and waiting a couple months is a drop in the hat. That doesn't make the wait any better, so what to do as we wait? do what waiters do and serve others, that keeps me grounded. I pray for patience and peace and comfort for you all.

If Pluvicto works and reduces your metastasis all over your body it should also reduce the symptoms you’ve been having.

The same thing would be true of triplet therapy with ADT, a second drug and chemotherapy.

It doesn’t matter how highly recommended a urologist is, you want to see an oncologist preferably a Genito Urinary oncologist. Mayo would be a great place for a second opinion. You might be able to get an appointment sooner than your currently scheduled appointment.

Urologists Are good at finding prostate cancer and doing surgery on prostate cancer.. They are not experts on advanced treatment that you need. That’s why you need to find yourself a G U oncologist. Mayo has them. Triplet therapy, Pluvicto and Chemotherapy are not part of a urologists bag of tricks. They can’t keep up with the latest that is going on in prostate cancer like a GU Oncologist can.

I just double checked and the doctor we'll see at UNC is Genitourinary Oncologist.
Still 9 days seem so far away, but I know that my husband dragged his feet on going to the doctor so a week more is not a "big" deal......

I just completed the PSMA and the MRI necessary to determine if the Cancer has spread. I meet with the Dr's next week and you are right the waiting is no fun. It's almost impossible to not look up stuff on the internet and find the horror stories. I can find stuff to distract myself from thinking about it. But my brain and I fight and my overthinking/anxiety almost always wins. You and your husband are in the right place. This is an amazing forum. The support on here is fantastic. I feel better when I post because I don't feel so alone. You might try distracting yourself and your husband by making some of your favorite foods, or going someplace nice like a museum. Like your husband I don't really have symptoms I just pee a lot. My brain might be better if I looked terrible or felt worse. All of us have similar experiences and the collective knowledge on here is fantastic. We are with you and hope you get the best outcome.

It's really frightening finding that out. I was age 56 when I learned that I had stage 4 prostate cancer and that it had already spread to my spine (the tumour compressed my spinal cord so much that I was paraplegic for a while). It was also totally unexpected.

As Jeff mentioned, when the stage 4 cancer is polymetastatic like your husband's, the treatment strategy is different, and will likely involve chemotherapy, Pluvicto, and similar approaches. Your husband is in a tough spot, but don't give up hope! Granted, mine was oligometastatic (though it was a huge tumour), but 3 1/2 years later, at age 60, I'm in full remission, walking again, and living an almost-normal life, with the hope of many years ahead.

The progress in the last few years on prostate-cancer treatment has been nothing short of stunning, and not all of the innovations have filtered down to local hospitals yet. That's why it's so important to get to a research centre (at very least, a cancer centre that's affiliated with a university med school, where the oncologists are also researchers and lecturers).

In the meantime, here are a couple of places to get more information:
https://www.scientificamerican.com/article/treating-prostate-cancer-at-any-stage/
https://www.amazon.ca/Patrick-Walshs-Surviving-Prostate-Cancer-dp-1538726866/dp/1538726866
And finally, don't forget to take care of yourself. You still need time by yourself and time with your friends: you'll be able to support your husband much better that way (and I'm sure he'll agree that you should have that time). There might also be support groups for caregivers that you can join.

beaquilter, gather your husband's reports and send them to 'Duke and Mayo with your consultation request. If you are completely satisfied with the (probably medical) oncologist you'll see on the 17th, you can cancel the other requests.
You might start looking at checkpoint inhibitors. https://www.mdanderson.org/cancerwise/what-s-new-in-immunotherapy-for-prostate-cancer-treatment.h00-159697545.html
Call the place that performed the biopsy and ask that they order a Decipher Test. The genetics of the tumor itself may give a better idea of which medications would be the most successful.
His care will be better with you on the front line.
I don't think you should wait to request other consultations, because you'll end up waiting anyway.
Between now and the 17th call for cancellations.
Bless your struggle with luck!