Latest/best practice for metastatic cancer is to do both: a high dose of radiation to the prostate (and individual metastases if oligometastatic) to "go in for the kill", _and_ ADT + ARSI to keep down any individual cancer cells that the radiation missed. If polymetastatic, then toss in chemo, too. And they're currently researching introducing Pluvicto at an earlier stage as well (though it's still in trial for that, I think).

This is a big shift from just a few years ago, when they figured metastatic prostate cancer was incurable, so they'd try one treatment at a time, moving to the next when it failed, with the goal of keeping you alive and comfortable for your final couple of years. 🙁

Now the approach is more shock-and-awe: hit that f***er hard with everything they've got, all at once, with the goal of overwhelming it. It won't always work (yet), but at least we have a very reasonable hope now of long-term survival now, even at stage 4.