@northoftheborder has zeroed in on what is usually done with the situation like yours?.

If everything is strictly in the bones radium 223 (Xofigo) Is one treatment that works for a lot of people.

I do not understand why your doctor has not discussed chemo or Pluvicto With you. They are the standard along with the drugs you are already on.

Any of those three treatments is sort of standard if you have more than five metastasis.

Where are you going for treatment? Have you spoken with a medical oncologist about your treatment?. In your case, a Genito urinary Oncologist would be the preferred type. They specialize in prostate cancer Unlike most medical oncologist, who work with many types of cancer. It might make a lot of sense to get to a center of excellence to get further treatment. It could be you are already at one, but a second opinion could not hurt at this point.

I was a Gleason seven in 2010 and had surgery, But it came back 3 1/2 years later because I have a hereditary problem BRCA2. My cancer has come back four times and I’ve had a metastasis on my spine zapped, but fortunately there was only one. With the right treatment, he could have many more years please do get a second opinion.