Your PSA number seems relatively low considering the Gleason 9 result. I wonder if that would impact treatment options. Did the doctor explain anything? Hope for the best.

There are a lot of variables, so we can just share some ideas and experiences.

If there are just a couple of bone metastases in addition to the lymph nodes, then your cancer is oligometastatic. If there are lots of bone metastases, then it's polymetastatic.

If your cancer response to hormone treatment (PSA goes down after a few months), then it's castrate-sensitive. If not, then it's castrate-resistant. Castrate-sensitive cancer often evolves into castrate-resistant after a few months or years, but new drugs can sometimes delay that process for much longer.

For polymetastatic cancer, treatment will often involve chemotherapy and/or Pluvicto (radiation administered internally). For oligometastatic cancer, they will often radiate each of the metastases, and maybe your prostate as well.

For hormone therapy, in addition to the traditional androgen-deprivation therapy (ADT), you will likely be put on ARSI like one of the -lutamides.

Personally, I've have oligometastatic, castrate-sensitive prostate cancer since 2021, and treatment has prevented any progression since then.

Best of luck.

If you don’t have more than five metastasis, then you can have them zapped with SBRT and maybe at the same time zap your prostate. Question is what did the biopsy show? Was there any cribriform found? Other major issues in the biopsy?

If you have more than 5 metastases then they frequently do triple therapy ADT plus an ARSI (Zytiga or a lutamide) and chemotherapy.

They could do Pluvicto instead of chemo, not the standard but it is approved.

My Dr didn’t go over the results in a lot of detail, the biopsy showed 5+4 with metastatic to the prostate nerve, I asked what now? He said we do Pet scan and go from there, the pet scan show bone and two lymph nodes, so he scheduled a consultation with an oncologist so that will be next, I have to admit that I’m a little at loss, I didn’t not even know what I should had asked I know the sooner I accept the fact the better off I’m will be.

Thank you Jeff
Zzotte

It seems like you might be able to better advocate for yourself if you got the full results of the tests that have been done, like the biopsy, Decipher (if done), etc. While we cannot tell you what to do, we can look at that and tell you our own experiences based the same or similar results.

I forgot to welcome you to the club within a club (metastatic prostate cancer). 😕

As @jeffmarc mentioned, going to a decent multidisciplinary cancer research centre is critical at this point, because treatments for stage 4 PCa have changed enormously over the past few years, and the word hasn't gotten out to all the smaller practitioners yet.

If treated quickly with the latest best practices, it might become more like a chronic disease than a terminal one, at least for many years, and maybe indefinitely.

There are no guarantees, but we have genuine hope now.
https://www.scientificamerican.com/article/treating-prostate-cancer-at-any-stage/