When I read through advanced situations like yours, as I read the details I make a list of diagnoses and therapies, as well as questions, in order to see where things are going and what’s next:

> what were your PSA & Gleason scores pre-primary treatment?

> what primary treatment did you have?

> what are the SUVmax scores (in the PSMA PET scan report) of the lesions in your lungs and lymph nodes?

> what is your testosterone level now?

Hormone therapies you’ve had: Zytiga (abiraterone), Xtandi (enzalutimide), & Zoladex (goserelin).

> since you have castration resistant prostate cancer (CRPC), is the Zoladex doing anything?

Isotope therapies you’ve had: Pluvicto (Lutetium-177)

> Other possible treatments: chemotherapy; immunotherapy; PARP (poly-ADP-ribose polymerase) inhibitor therapies.

There were combinations of drugs approved (by the FDA here in the U.S.) in 2023 for certain mCRPC patients:

> Olaparib plus abiraterone and prednisone or prednisolone for the treatment of patients with BRCA-positive mCRPC.

> The PARP inhibitor talazoparib in combination with enzalutamide (Xtandi) for patients with homologous recombination repair (HRR) gene–mutated mCRPC.

> The combination of niraparib and abiraterone acetate (Akeega) plus prednisone for patients with mCRPC with deleterious or suspected deleterious BRCA mutations.

And there are ongoing clinical trials with an isotope therapy that is more powerful than Pluvicto - it’s called Actinium-225.

As for other possible therapies in the pipeline, attached is a chart from a webinar I attended a couple of years ago showing both diagnostics and therapies that were in the pipeline at the time.