So no, those of us with metastatic prostate cancer are no longer just sitting around, waiting to die after the ADT stops working. Things have changed a *lot* over the past few years.

It sounds like your cancer is still castrate-sensitive and is responding well to doublet therapy (Orgovyx + Abiraterone). Metastatic castrate-sensitive prostate cancer (mCSPC) is a pretty-good place to be these days, relative to the past. They used to automatically consider it a terminal disease, but there's an increasing belief in the oncology community that it might be turning into a chronic disease — one that can be managed for many years or even decades, like diabetes, HIV, or Parkinson's. The cribform does raise the stakes a bit, as far as I understand.

You're only 31 days into doublet therapy, and you've already had a huge PSA drop. If that continues over the next couple of months, I wouldn't give up saving for retirement quite yet.

Some notes:

1. Doublet therapy with ADT+Abiraterone provided very effective for mCSPC in the STAMPEDE trial, but doublet therapy with the -lutamides (Enzalutamide, Apalutamide, or Darolutamide) did even better in their own trials. You can progress to a -lutamide if/when the Abiraterone stops working, but you get most of the benefit if you use the -lutamide right from the start; unfortunately, the -lutamides are very expensive — like $12K+/month — so in the U.S. you need good insurance.

2. As @jeffmarc mentioned, metastasis-directed therapy (MDT) is rapidly becoming standard of care for mCSPC. You're right on the borderline between oligometastatic (treat with radiation) and polymetastatic (treat with chemo or Pluvicto), but the idea is to attack the cancer with everyone they've got *now*. That's a big change from a few years ago, when they'd gradually escalate the treatment, always trying to keep something up their sleeve so you wouldn't lose hope, but the "shock and awe" strategy is proving more effective.

3. For low-burden mCSPC (oligometastatic), research also suggests there are big benefits from radiating the prostate itself, but the same benefits haven't appeared for high-burden (polymetastatic). Again, I'm not sure I fully understood your posts, but it looks like you're near the borderline between the two.

^^^ None of the above is meant as advice (I'm not qualified), but just as questions to raise with your oncologist for a more-informed discussion.