How would you treat a newly diagnosed hormone sensitive high risk prostate cancer with one small lung metastasis and no other evidence of metastatic disease per PSMA PET?

I think there is no solid answer to this. De-novo visceral metastases are very rare in mHSPC, and lung-only oligometastases on PSMA-PET are even more rare. Since lung metastases is expected to be visible on CT, this is undeniably a high-volume disease based on the CHAARTED criteria.

Patients with vi...

My preferred management strategy would be related to the likelihood I thought the lung lesion was (1) a prostate cancer metastasis, (2) a primary lung cancer (which can be PSMA+), or (3) a false positive from another process. Lung cancers can be PSMA-avid, and having a lung metastasis at diagnosis w...

Given the clarifications provided (lung met is biopsy-proven prostate cancer and visible on CT), systemic therapy is clearly the priority. Drs. @Dr. First Last and @Dr. First Last have provided nice summaries of the evidence. I assume neuroendocrine was ruled out. Also, this is a great situation for...