If you have one Gleason 10, you are a Gleason 10 the other numbers are irrelevant. That is very aggressive.

You really do need that PET scan to make any decisions about what To do. If you have metastasis outside the prostate, then the treatment is very different than if you have none. They would more likely lean toward radiation in that situation and if you had more than five metastasis, they would usually want you on triplet therapy with ADT an ARPI and chemo or Pluvicto.

You should make sure to get an hereditary, genetic test. I’m sure your doctors would agree that you need to have one since you are relatively young and have such a severe case. It can give you some ideas about what’s going on in the future, It may not change your treatment plan right away, but it can change it in the future.

I wish you would have included your PSA as part of this question because that is a real important piece of information.

As you may know, Neuroendocrine cancer can be very aggressive. I know a couple of guys that had it with prostate cancer and they aren’t around anymore because there just aren’t great treatments for it. Usually, you go on chemo with the addition of carboplatin. There are some clinical trials testing new DLL3 drugs and some look promising. It’s a big problem with breast cancer as well.