we are discussing our protocol now with oncologist, radiologist + cardiologist.
The idea is a multimodal aggressive approach for oligometastatic PCa (T3b N1 M1, Gleason 9, PSA 29 now) with:
1) radiation + radiation to pelvis lymph nodes and metastasis
2) ADT + Zytiga
but we need also to do
Timing could be important because of side effects and best results.
Radiation could begin with ADT together, or, some argue to begin with ADT to get a very low PSA before radiation, but
In the meantime CVD risks could occur caused by ADT side effects, so maybe stents should be the first thing to do (they will require at least 6 months of dual antiplatelete therapy)
If stents first, there could be a problem with the stability of the "eluted drug" on the stent coating under radiation.
The stents wouldn't be that urgent (no symptoms under physical stress), but with ADT it could get worse, plaque could get instable...
So I really don't know the safest approach , a question of TIMING!
We will get a second opinion, but do you have one?