SBRT on T8 Only vs Lower Dose Pluvicto and ADT

I am a Care Partner for husband whom has Aphasia from 2 stroke 14 years ago. He is past the Medicare full retirement age. Diagnosed with Stage 4B Oct 2023 (Lympth Node biopsy, not prostate biopsy). Confirmed with Pet/PSMA scattered throughout skeletel hip, spine, shoulder and several lymph nodes. 2nd PET/PSMA 6 months after Enzalutamide and 2 months of Talzenna smaller lesions, and 3rd PET/PSMA no lesions on skeletel except T8. Stable update in prostate. No visceral metastisis has shown up. No other imaging except prior to biopsy PSA was as high as 717 and CT without contrast showed swollen scattered lymph nodes in several areas. His lowest PSA was 1.15 around the time he had to stop the Enzalutamide . After stopping the Talzenna his PSA went up to 2.0 and now only therapy is the Nubeqa with no ADT. We have been given choice of Pluvicto, or add ADT (Relugolix) or SBRT to the T8 only. For some reason Oncologist has changed mind on the ADT and is suggesting only the SBRT now because my husband has Chronic Kidney Disease. Was told by the Radiation Oncologist that should get kidneys better before doing Pluvicto . At this point his PSA has risen in 2 months to 3.45. Regular PSA testing, no special PSA testing. Stage 4. Pacemaker with paroxysmal AFIB and frequent PVC's (dual and triple) and moderate heart valve disease. Neurogenic bladder issues from stroke and moderate BPH with frequent retention. After diagnosis started a short course of Bicaludamide followed by 11 months of Enzalutamide (6 months combo with Talzenna - a parp inhibitor due to Genetic & Somatic testing results. Was on half dose due to kidney disease). Had to stop the Enzalutamide due to cardiac AE's and eventually the Talzenna also due to the AE's with kidneys and AE's to kidneys due to frequent retention. Started Nubeqa (half dose due to kidney issues) with no ADT. We are not using a Center of Excellence (another story for another post perhaps later) but a good cancer center. There is no genitourinary urologist in Georgia! We have a Nephrologist, a Urologist (in process of 2nd visit for 2nd opinion), and Medical Oncologist Hematologist, and a Radiation Oncologist (from same center of our Medical Oncologist). One month ago was informed by MOC that he was not sure if my husband is still hormone sensitive still or becoming resistive and this recent appt he clearly indicated by his comments that my husband is now resistive to the hormone therapy (Enza, Nubeqa, ADT??). I had to finally say to the Oncologist " I know that you have only 15 min appts with us but please, we have full secondary insurance so spend appropriate time with us so we can discuss these options". I have been researching, have printed out the actual NCCN updated guidelines as of 2/5/2025 and have watched all the videos that pertain to my husband's scenario from PCRI.ORG, the ESMO video updates, the Urology news, etc. I have educated myself because my husband has Expressive Aphasia( he has diffculty speaking, writing, typing). I asked about Radium 233 since the Peace III trial showed good results with Enzalutamide for Oligeo mets and was told that Radium 233 will not do what is needed for current T8 situation and the side effects would be worst than Pluvicto. We were offered Pluvicto but at a lower dose but my husband has chosen SBRT - after we have a Telehealth appt with the Radiation Oncologist explaining the dosage and the fractions and what type of imaging would be used to assure safety with spinal cord. Medical Oncologist keeps ignoring our request for a Ctdna lab test and responded with a question back to us "what difference would it make, what therapy would be added or changed to help"? He always returns a question back to me when i ask a question. UGH! I know this is a long post, since it is our first post we just want to give history. Advise on SBRT, vs Pluvicto (lower dose and should it be given with or without ADT and/or Nubeqa) and why no ADT (is it because it should not be taken while on ADT?).