Absolutely. That makes perfect sense. The hail-Mary passes in the final months of cancer are an entirely different thing. They are (and should be) a very-personal decision.

My childhood friend was still well under 65, with lymphoma metastasised to his pancreas, and other treatments had failed. He choose CAR-T, fully understanding that it was a long shot even to get him an extra year. He went in with his eyes open, the treatment was brutal, and he accepted that he was out of options when it didn't work.

Others would not have made that decision, and opted for less pain and more presence in their final months. Both are reasonable choices.

But a de-novo stage-4 prostate cancer diagnosis isn't necessarily like that. Oncologists can now often keep someone alive for many years (even indefinitely, maybe?) just with radiation therapy followed by a few pills every morning, that — for many patients — cause nothing worse than mild fatigue, hot flushes, gynocomastia, and sexual dysfunction. There's chemo and Pluvicto to fall back on if/when the cancer progresses.

Not everyone is that lucky: sometimes the cancer is already in vital organs (rather than bones or lymph nodes), and some patients develop severe complications like heart disease from the hormone therapy. But for many stage-4 PCa patients now, especially those in their 50s, 60s, and even 70s these days, there's a huge potential upside and small downside to so-called "aggressive" treatment (not really all that aggressive compared to most other stage-4 cancers).

So my point is that it's good doctors are talking about this — they should *always* be talking about this — but for many cases, it's not the same hand-wringing, soul-crushing problem it is for other advanced cancers. We *know* innovations over the past few years like the -lutamides, doublet therapy for oligometastatic cancer, and triplet therapy for polymetastatic cancer work for either a majority or large pluralty of patients with advanced PCa, buying years (sometimes decades?) rather than just weeks or months when they succeed, so we've passed the "hail Mary pass" phase for many cases of stage-4 prostate cancer.

That does feel a bit like a miracle. ❤️