It is a little unusual to be given Zoladex in the United States. Are you outside the USA? That is what is causing your brain fog.

The PSMA PET scan has shown that you have metastasis in different spots. While being on the drugs can make them smaller it’s unlikely to eliminate them and they will usually come back if you stop the drugs. There are more than one treatments for bone and lymph node mets. They can be zapped with SBRT radiation if they are not close to organs that could be damaged. You could also get Pluvicto Or chemo if there are many of them. An SUV of 9 or 10 is implies there is cancer in the lymph nodes and bone. The 5.4 on the spine is elevated but not necessarily cancer.

While your Gleason score is not real aggressive, when they do a biopsy, they only biopsy one percent of the prostate. It’s very possible that there is a higher Gleason score in your prostate itself that could only be found out by doing more biopsies or surgery to remove it.

Zytiga Works great for some people I found it caused me a lot of trouble, Many hot flashes, Gave me high blood pressure and Multiple afib events. Xtandi (Enzalutamide) Is easier to deal with and newer studies have shown it is preferable to go with a lutamide over Zytiga. I started with Darolutamide (Nubeqa) Because I know many people that are on it and have said that it has very few side effects. Xtandi Does cause fatigue for some people, Very few report that with Nubeqa. If you are not in the USA, it is hard harder to get Nubeqa In some countries. Casodex is a lutamide, Biclutamide, but it is not nearly as effective as xtandi or nubeqa. Nubeqa Is not supposed to pass the blood brain, barrier and cause additional brain fog.

You have to realize that most people, even those with advanced prostate cancer, have no symptoms at all.

Prostate cancer is a chronic disease for most people not a deadly disease. Only about 10% of people that get it die of it, most die of something else.