Looking for advice on next steps. 71yo in excellent health otherwise.

MRI in Jan 25 showed probable lesion and possible metastasis. Biopsy in Feb 25. Gleason 8. PMSA Pet Scan in March showed spread to one lymph node, pelvic bone metastasis, and possible rib metastasis (but very low score). Started 2 years of Orgovyx and Xtandi. Consistent with the STAMPEDE trial for low volume metastasis had 20 sessions radiation for the prostate and the node in May 2025. Sept 25 PMSA showed remission with much lower SUV values in both radiated areas and bone. PSA is undetectable and testosterone is in single digits. So far so good.

Jan. 26 some blood in stool. Diagnosed as radiation proctitis in May 2026 by colorectal surgeon. Did 6 weeks of Sucralfate enemas and bleeding is much less - once every few days and a small amount. What to do next?

Surgeon suggests either active monitoring, formalin, another round of Sucralfate, or hyperbaric. Says it is my call. What would you do in my case? To be honest it doesn't bother me that much. Thanks in advance.