@swl1956 @surftohealth88 Just so. I believe a micrometastasis needs to reach millions of cells before even PSMA-PET can detect it. And for that matter, needle biopsies are almost literally needles in haystacks — if they tell you that your Gleason score is 4+3 for example, that's just the highest they found in their samples. They might have narrowly missed a spot with Gleason 8 or 9 too small to register on the MRI.

There is no way at all to know for sure what's happening with prostate cancer. We're just taking samples, making scans, and playing odds.

That's why I (personally) have been happy to err a bit on the side of overtreatment, to tilt the odds more in my favour with stage 4 PCa: I'd rather live *with* some uncomfortable side-effects than die *without* them. YMMV.