This thread is fine. You're facing a really hard choice, especially in a context where you're worried about hospitals wanting to bill more (I didn't have to deal with that here: they get fixed-funding from the government no matter how much or little they treat me, so there was no benefit to them in overtreating).

There are lots of people here in the forum with stage 4, and we all (obviously) think it's worth treating. The possible difference for your husband is that it's in his lungs in addition to bones and lymph nodes. I can't give medical advice, obviously, but based on my observations from a month in the cancer ward (when I was paralysed), things don't seem to become desperate until the cancer gets into somewhere like the liver or pancreas.

It's really worth consulting an expert who *won't* be treating your husband, so that they have no potential financial gain from whatever they say. It's not to tell you what to do, but just to help you consider different scenarios. When I was first diagnosed, they told me I would typically have up to 5 years to live (at the outside), but that I might even make it to 7 if I were very lucky, because I was otherwise young and healthy. Within 18-24 months, my cancer would start spreading more, and I'd be on chemo and other treatments to try to slow it down. Obviously, I felt a lot like you and your husband feel right now, and started putting my affairs in order as much as I could (paralysed in a hospital bed at the time).

The thing is, those predictions are based on old data, and cancer treatments are changing so fast that no one really knows what our outlook is any more. My team quickly removed the time limit for me (I know I'm lucky), and implied that I might continue in my current remission for many years. No guarantees, of course, but also, don't assume your husband just heard his final sentence.

As I mentioned, the question mark for me in your husband's case is lungs (I'm not sure what that means for him, compared to the other metastases). That would be the thing to ask the expert about in as much detail as possible. But in my totally non-professional opinion, it's definitely worth starting on ADT and one of the -lutamides at an absolute minimum. If they bring your husband's PSA down quickly, then the cancer is still "castrate-sensitive", and it will at least have stopped spreading for a while, so you will both some time to consider more aggressive measures like chemo and/or radiation. If they don't bring the PSA down in 2–3 months, then the cancer has become "castrate-resistant", and you might have to decide about those measures sooner. But ADT and the -lutamides are just medications: he can try them out, and then stop them if he needs to. They're the easiest next step.

The latest medical studies show that even though the cancer has spread, it is still a good thing to also treat the prostate, usually radiation. It can prevent future spread.

That may not be the first thing they do, however. Many have discussed the options.