My interpretation of this report is that you have hormone sensitive metastastic prostate cancer and a recurrence of the cancer in the prostate or it is the original tumor that never went away. No previous study for comparison.
In general the initial treatment would be ADT with lupron or similar or castration plus abiraterone (Zytiga).. Along the road could be other treatment options such enzalutamide , chemo and immunotherapy with Provenge.
The tumor and the metastasis may be susceptible of local treatment with some form of radiation, IMRT or stereotactic radiosurgery. You should consult with a radiotherapist besides your oncologist. Theoretically they could be also treated with surgery. All points to discuss with your oncologist.
If the cancer is PSMA positive (PSMA is a protein present in the inside and surface of the cancer cells) it can be treated with Lu 177 PSMA which is a nuclear medicine therapy developed in Europe mainly in Germany and very effective in some patients with metastatic disease.
There are at least 3 clinical trials going on for castration resistant metastatic prostate cancer.
The first things is to determine if the metastasis are PSMA positive.
A Gallium 68 PSMA PET/CT will identify metastasis is they are PSMA positive with a PSA of 0.2 or more. There is an ongoing study a UCLA got Ga 68 PSMA PET/CT:
I was treated with Lutetium 117 in 2016. I had a multitude of metastasis in the lymph nodes in the pelvis and abdomen . After 1 treatment the metastasis were gone.
The treatment kills cancer cells castration resistant and hormone sensitive in the bones and in soft tissues. It is a systemic therapy. Very well scientifically documented treatment.
Your PSADT is more than 15 months so I believe you will have a good response with a systemic therapy or a combination of local and systemic therapy.
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