You are seeing the wrong doctor. You are way beyond the expertise of the urologist, They are in no way informed to give you an educated opinion about what to do with your case. Urologist handle urinary issues and may do prostatectomy. They love to make you think they can do more because they make a lot of money treating you, especially giving you drugs.

You need to get to a center of excellence or find a Genito Urinary Oncologist, The oncologist that specialize in prostate cancer. You don’t want a medical oncologist since they don’t specialized in prostate cancer and handle all different types of cancer. You have an advanced case, and it needs to be seen by a trained doctor,

Your life is dependent on getting this right. Don’t go to the wrong physician.

Of course, if you live in Canada, it’s a little more difficult to get the correct treatment for such an advanced case. But even there a urologist is not a doctor you should see.

Perhaps a PET scan with a different tracer will show uptake. The older Axumin scan might show something.