@briang1958
Definitely go to Mayo in Minnesota and speak to Dr. Heath. She is a really great oncologist that speaks at many meetings and is really loved by her patients. You would have the best options for treatment from her.

You might want to ask about using estradiol instead of ADT. That can avoid a lot of the side effects you had but also work to reduce your testosterone. It definitely sounds like you need an ARPI, Darolutamide would be the best.

Get yourself a really good oncologist, One that specializes in prostate cancer. You have a very advanced case and you don’t want to encounter the pain that prostate cancer can cause if left untreated.