Well, there is a lot of debate about whether advanced prostate cancer can be cured or not.

To say ADT does not kill prostate cancer cells may not be correct. Since sone PCa cells must have testosterone they die when in a low testosterone environment. That is why as I understand when we go on ADT mono therapy initially our PSA drop and tumors shrink.

Some cells of course adapt and are able to live and thus replicate in a low T environment. That's a reason to do doublet therapy, adding a 2nd ADT, an ARI which can shut down T from the adrenal glands and prevent the PCa cells from binding with and thus using T to survive and advance.

Still, that doesn't get them all. So now you go to triplet therapy by say adding chemotherapy or perhaps radiation. Both kill prostate cancer cells.

Sorry about your situation with side affects from radiation, I've had three -SRT, PLN and now SBRT, 69 total, no SEs.

There is some discussion about advanced PCa as being curable.

oligometastasis
(AH-lih-goh-meh-TAS-tuh-sis)
A type of metastasis in which cancer cells from the original (primary) tumor travel through the body and form a small number of new tumors (metastatic tumors) in one or two other parts of the body. For example, cancer cells may spread from the breast to form one or two new tumors in the brain or spread from the colon to form new tumors in the liver. These types of tumors may be treatable.

So, when you have your scan and if it gives a location or locations you have a decision to make. If you are going for the cure, unlikely mono therapy gets you there. So, doublet or triplet therapy may be what you discuss with your medical team.

If not a cure, then think about options which provide a statistically significant probability of a durable and long term remission.

I just finished a 4-1/2 year remission, mine is back, Plarify scan showed a single PLN so we did five SBRT and are planning for six months of Reloguix then assess. I am not a fan or advocate of lifetime ADT and my medical team knows to suggest it only if defined periods are not working. We are not there.

Keep in mind that even if your image shows one or a few, say 3-5 sites there are likely many more, just too small to be seen by imagining. That's why systematic therapy is almost always in play in a treatment decision for advanced PCa unless it's palliative in nature.

Kevin