All of this is definitely aggressive
Cancer Association: While normal PTEN maintains genomic stability, loss of this segment is strongly associated with high-grade, aggressive cancers (such as prostate and endometrial) and poor survival outcomes.
PubMed Central (PMC) (.gov)
https://pmc.ncbi.nlm.nih.gov/articles/PMC4310752/.
The one treatment limitation is that Pluvicto Does not work well with someone that has PTEN. That doesn’t affect chemo or other treatments.

HRAS Q61K
The HRAS Q61K mutation in prostate cancer acts as an oncogenic driver that locks the HRAS protein in a "constitutively active" GTP-bound state. This prevents GTP hydrolysis, leading to uncontrolled signaling through the RAS/RAF/MAPK pathway, which promotes cancer cell proliferation, survival, and aggressive behavior. Although rare in conventional prostate cancer, it is seen in rare subtypes like PIN-like ductal carcinoma.

Similar RAS mutations, especially at codon 61, are generally associated with poor response to standard treatments and higher rates of recurrence.
PubMed Central (PMC) (.gov)

MED12 L1224V
The MED12 L1224V mutation in prostate cancer is a somatic, hotspot mutation occurring in exon 26 that often promotes the progression to aggressive, castration-resistant prostate cancer (CRPC). This mutation disrupts the MED12 protein's ability to properly regulate cell growth, often driving tumor growth even when androgens are depleted.

This particular, genetic problem may cause issues with drugs that are given for prostate cancer. You should discuss this with your doctor. You need a Genito Urinary Oncologist To be treating you. Someone that is aware of what’s going on genetically. He definitely should be working with the center of excellence on treating this. I know that UC SF has a specific group that handles genetic issues.