To expand the topic a bit, one of the biggest breakthroughs for metastatic prostate cancer this decade was the simple realisation that if a certain percentage of prostate cancer cells will eventually try to turn castrate resistant, wiping out as many of them as possible at the start — and keeping most of the rest dormant — means there will be many fewer cells that are candidates for mutation (n% of small number vs n% of big number: maybe so few that they can't build enough of a tumour to survive the body's immune system??).

That's why for metastatic prostate cancer, we've seen the big shift from sequential therapy — start gentle and escalate to a new treatment each time the current one falters — to full-on, attack mode, shock-and-awe, hitting the cancer with everything we have right at the start. This brings us to approaches like doublet therapy (ADT + ARSI for oligometastatic) or triplet therapy (ADT + ARSI + chemo for polymetastatic), metastasis-directed therapy (MDT), primary/pelvis-directed radiotherapy (PDRT), and so on.

It's also possible that they'll add surgical debulking of large lesions to the list before too long, because anything that decreases the number of cancer cells is a good thing. I did have debulking surgery in 2021, but only to save my spine and mobility; it's just a happy coincidence that it's being researched now as a primary path for cancer treatment, and may have helped me achieve an unexpectedly good outcome (so far 🤞) from what started out as a really desperate situation.

The lesson is that with metastatic prostate cancer, STOP BEING POLITE! (yes, I know it's a Canadian writing this). We have to fight dirty: slap it in the face, throw sand in its eyes, pull its hair, knee it in the groin, and don't give it a chance to catch its breath, figuratively speaking.