@bkandrew

1. 10+ hours of emergency debulking surgery to decompress my spine (I suddenly lost use of my legs four days after I was admitted to hospital with balance problems), and spinal fusion from T1–T5: that's not a standard treatment because of the risks of spinal surgery, but I needed it *immediately* to have a hope of walking again, as a side-effect, it significantly reduced my secondary tumour burden.

2. About a week after the surgery, I started on Apalutamide (Erleada) and ADT (initially Firmagon, now Orgovyx). That's the "doublet" therapy.

4. Four weeks after surgery, I received 20 gy of radiation in 5 fractions to my spine to destroy any remnants of the secondary tumour that the surgery might have left behind. After that, my PSA rapidly fell from over 67 to undetectable. That's the practice of "zapping" individual metastases for oligometastatic cancer.

5. About six months after surgery, 60 gy of radiation in 20 fractions to treat the primary tumour in my prostate (which was still too small to detect with an MRI or digital exam). That's what Dr Scholz describes in his book as "attacking the mothership".

The debulking surgery was unusual, but it probably did help; the rest is latest best practice for castrate-sensitive oligometastatic prostate cancer, based on major studies like STAMPEDE and TITAN.