Did you discussed Pluvicto with the doctors,? I suspect you did, and it also was too much for him. If not at least ask the doctors, it treats the whole body and works quite well for some people.

You are correct doing a biopsy makes little sense since it wouldn’t change the treatment. Ask the doctor what benefit it would have considering how advanced the case.

Hormone therapy will probably make him weaker. He needs to exercise. That is the only way to get around the fatigue from hormone therapy. Going to the gym, a couple of times a week for an hour and walking every day would help with the fatigue. I am 77 and do more than that.

Is it possible for him to do something to improve his health so he can handle these treatments?

Better than hormone therapy, it would make sense for him to look into the patch study. The patch trial Completed in England recently and showed that estradiol worked just the same as ADT, but had many fewer side effects. It easy easier on your cardiovascular system, On your bones (osteoporosis), causes fewer hot flashes and less brain fog. If your doctor has not heard of the patch trial, there is a lot of information about it so come back and we can help you.

Even with his case there is hope that the existing drugs work, they usually do. If ADT alone doesn’t work Darolutamide has the least side effects of the next level drugs, I’ve been using it for 1.5 years and it’s kept me undetectable after 15 years with PC. You can ask your doctor about it when the time comes.