The waiting is terrible

I hope so too. Sadly, new innovations in cancer treatment don't reach everywhere at the same time — no matter what country you live in (I'm Canadian), the difference between the treatment options they offer you at a community hospital and what they might offer you at at a major Cancer Centre (Canada) or Center of Excellence (U.S.) can be dramatic — unfairly so in my opinion, because people should be offered the same quality of care no matter where they live or what kind of insurance they have.

That's really sad, I'm originally from Denmark and I know some of THAT system too, there's no ideal system right now, in the US doctors are CUT happy and a cancer patient is a mio. dollar patient, where in DK (Europe?) they are very cautious and won't do stuff because it costs the state too much, often people have to go to other countries for treatment.
We're in NC and will go to UNC (University of NC.... it has a med school attached to it) plus Duke is close to it, so we could go there too, don't know about insurance stuff and all that, but we'll do it one step at a time.

yeah we found out and researched the surgery part and found it's too late for that now and I get the triple cocktail thing.... we need to know our options because extending a life by a few months with tons of side effects won't be worth it.
We've researched a lot and I'm guessing we're stuck between a rock and a hard place!
We just want to know our options, if there even ARE options... or is it just doctors trying to rake up the bills?
I'll keep you all posted. Do you know if I should reply to this thread or create a NEW one?

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.

While following all the other good advice on this thread, I wonder if it would help with the waiting if you started to focus on the recommended lifestyle changes that you are sure to receive from your doctors? Mine are to reduce red meat to no more than 2x a month (I was eating some form of red meat several times a week before diagnosis and treatment) and to have cooked tomato products 3x a week (e.g., sauce, stewed tomatoes, tomato juice) and increase fast-paced walking to 30 minutes 5x a week.

And for what it's worth, I went into my first meeting with the oncologist adamantly opposed to ADT but after having the Decipher test showing my cancer cells are high risk, I relented. Yes, there are some side effects, but they are manageable for many of us.

Wishing you and your husband the very best.

Here are some more of my lifestyle changes I failed to include.
Limit things high in animal fat (whole milk, whole cheese, and ice cream).
Eat cruciferous vegetables 3 times per week (broccoli, cauliflower, cabbage, brussel sprouts, kale).
The lycopene rich foods (found in cooked tomatoes: pasta sauce, stewed tomatoes, tomato juice, also in watermelon).

He's taking supplements, super strict keto diet, no sugar or carbs, mostly salads and veggies and then salmon, plus juicing once a day

Beaquilter, I have nothing to add to all the excellent suggestions made by the many men on this board; their advice comes from experience, grit, determination and a never say die attitude.
You must NEVER think that treatment for your husband is too late, useless, or for nothing. All of the Stage 4 members who have responded to you were in similar condition when their struggles began, and yet, here they are years later.
As was said, ADT IS A MIRACLE!! If other types of cancer had medications that literally STOPPED them in their tracks, newspapers around the world would publish CURE FOR CANCER FOUND!
So please start there, get the progress arrested and go from there.
And for what it’s worth, there is NO ANSWER to your husband’s situation; it’s going to be a long haul which will require discipline on both your parts but you will get through it.
Someone once told me that the most difficult option was probably the right one; there are no short cuts in this case, it requires the veritable “kitchen sink” triplet therapy and whatever else they can come up with to turn this dire prognosis into a low grade chronic illness.
THAT is what this disease is - a chronic illness like Type 1 diabetes which has no cure but can offer you a long, comfortable life if you treat it appropriately.
I’m not gonna wish you thoughts or prayers - or even “the best”, but I will assure you that this feeling of helplessness and despair will pass and the two of you will do whatever has to be done to beat this.
Phil

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.

To build on what Jeff wrote, here's the sequence that things happened for me:

T: Emergency debulking surgery on the spinal lesion, and biopsy identifying it as stage 4 prostate cancer

T+2 weeks: started on ADT (Firmagon) and ARSI (Erleada).

T+4 weeks: post-op radiation to the surgery site on my spine (20 gy of SBRT over 5 sessions)

T+3 months: PSA reduced from 67 to undetectable (< 0.01)

T+3½ months: home from hospital (in a wheelchair at the time)

T+6 months: full "curative" dose of radiation to my prostate (60 gy of SBRT over 20 sessions); went into last session using a walker rather than a wheelchair, and rang the bell

T+12 months (give or take): oncologist tells me I'm in full remission

T+2½ years: switch from Firmagon injections to Orgovyx pills (big improvement in quality of life)

T+3½ years: PSA is still undetectable; I have about 75% of my old mobility back, and am living a mostly normal life

Everyone's path will be different, but we didn't know how all of this would go when we started out. I made my wishes clear ("I want to fight") and the oncology team listened ("we'll throw the kitchen sink at it"). My care is classified as "palliative" since my cancer is incurable, but Ive been getting so-called "curative" levels of treatment anyway. I kept advocating for my self, taking treatment sooner rather than later whenever I was offered a choice. Some of it was rough, but zero regrets.