IMRT may be a little aged to really be the best solution. SBRT can zap the prostate and metastasis with a lot fewer sessions. Are you being treated at a center of excellence? You have a serious prostate cancer case and you need to get the best treatment so that you can have a long life. I would want a Genito Urinary Oncologist handling my case with a Gleason nine, A medical oncologist works with all different types of cancer and can’t specialize in prostate cancer like a GU oncologist.

The question is, is he going to Radiate the prostate bed since you’ve already had the cancer get outside the prostate and mini metastasis are likely to be in the prostate bed, undetectable by a PSMA pet scan. At the latest PCRI conference a doctor made this statement?

“Seeds for metastasis were already there when surgery was done, waiting to grow.”

That sort of reinforces the need for having the prostate bed radiated when cancer has already gotten out of the prostate. Ask you doctor about this.

Was cribriform, Seminal, vesicle invasion or intraductal found in the biopsy?

Are you having the damage to your kidney removed? My wife had a partial nephrectomy to remove an issue with her kidney, Would that be possible or even beneficial for you?