Overwhelmed, what do I do next? Mutations In my Germline & a Tier 1 ATM Frameshift Alteration

[Shorehousejam]

My Germline is I’m missing a blm copy like a bloom syndrome drop

My Genomic Tier 1 is a ATM Frameshift Alteration

I have a battery of mutations listed in my profile bio.

My PSA in the last 4 months is rising from <0.06 in October to 0.46 last week.

I’m on Firmagon monthly, Zytiga with Prednisone, Metformin and Skyrizi for both plaque Psoriasis and a recent bout with colitis after discovering an h pylori infection since July 2023

I had a Davinci radical prostatectomy with pelvic lymph node removal, last March 2023

Gleason 8/9 Oligo metastatic with 3 lytic lesions, two resolved.

I have a mass reoccurrence on my prostate bed showing since May 2023 which my medical oncologist does not want me to radiate, but I’m compelled to do radiation in spite of colitis which is clearing up pretty fast

I feel this is why my PSA is rising.

Medical Oncologist wants to wait for 60 days or two more PSA cycles to do a pet scan.

What would I do next?

More docetaxel than a PARP inhibitor (medical oncologist does Not mention PARPi at all)

or do I change hormone therapy

Or

My medical oncologist seems hot on the throttle to do Lu 177 which with my mutations, may not be a good idea, as not much seems to be known how Lu 177 reacts in men with both germline and genomic mutation loads.

. I have seen stories of guys with mutations that seem to spread like wild fire with metastases much worse after Lu 177.

So, I’m very concerned. Help

[Shorehousejam]

Tall_Allen

Thank you for replying, would you read my post above, as I have both a blm copy missing in my Germline and an ATM Frameshift Alteration…

Please see this below, what does it, or how would this apply to me?

translational-medicine.biom....

[Maxone73]

I don't know if you are still looking, in case you are please check a study called BRCAAWAY