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Prostate cancer is present in most 90-year-olds who are autopsied and have died of natural causes. There is ordinarily no reason to treat them; surveillance is the operative word. The PSMA PET/CT scans determine the presence of cancer outside of the prostate gland, i.e., metastasis. The 'radioligand' [Lutetium-177] treatment is very expensive. It is effective in preventing progression of metastatic disease for both hormone-insensitive and hormone-sensitive disease. Initially, it was restricted to hormone-insensitive patients who had gone through chemotherapy as well. Authorised uses are progressing backwards. I suspect trials are already ongoing for non-metastatic (gland-limited) disease. It appears they now know who, genetically, will be great, medium, and poor responders to the currently approved radioligand treatment. Others are in the pipeline, likely with different response rates.
PS: I believe Johns Hopkins was studying a strategy to reduce metastatic disease with three injections of a therapeutic vaccine into the gland. Would it be an interesting add-on to combine approaches in one of the study arms? There might be an additive benefit.
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@thmssllvn Greetings! Regarding your following statement. . . . "Prostate cancer is present in most 90-year-olds who are autopsied and have died of natural causes."
This statement appears to be absolutely true. In fact, my original radiation oncologist (in 2018), once told me that it was very likely that every single man on planet earth over the age of 70, had (or has) prostate cancer of one form or another (mild and dormant, active and aggressive, or something in-between), and he was adamant about it! He pointed to a published, but (as I recall), a somewhat 'dated' article from the Detroit, Michigan (?) area (maybe Warren County?), or thereabouts, wherein a group of researchers, went back and looked at post-mortem prostate tissue samples, from a huge number of males of all ages (like age 12-90!), regardless of their cause of death, and reported that a vast percentage of them showed "cancerous" cells of the prostate.
I regret that I don't have a firm or better memory of the details, or a link to that actual article, but let's just say that I recall it making an impression on me at the time!