@rnpalarino1 Sometimes, PCa cells are so diffuse that no scans can pick them up. Some of the new thinking involves letting the PSA go to 2.0 - yes, whole integers, not decimal fractions.
The idea being that the clump of cells producing the PSA will then be large enough to see on a scan; it can then be zapped with SBRT.
Personally, I am not sure about this because if you let ONE lesion grow to a discernible size, how many more are waiting in the wings to do the same thing?
And then if the lesions are too numerous ( I think anything over 5 of them?) you now enter Pluvicto territory - generalized radio-isotope infusion as a form of chemotherapy… it is, indeed a gamble!
The other option is to follow the advice of @jeffmark and combine the ORGOVYX with Darolutamide - this was you block both the production of T and its binding sites on PCa cells, preventing castrate resistance.
Good Luck,
Phil