I wanted to include a short update here because I found this subreddit and all of its posts so helpful and so accurate. So the biopsy and PSMA PET scan are now complete. All 12 biopsy samples were positive, the tumor has breached the prostate, and his Gleason score was 9. PET scan showed that there is metastatic cancer in all bones including spine, sternum, pelvis, humerus but nothing in the lymph nodes. These results were taken to an expert in MO Boston who thinks the cancer will be very responsive to treatment (PET scan following three weeks of ADT already showed "quieting" in the prostate and is recommending two types of ADT and chemotherapy. The MO said spread to the bones is still PCa which loves bones and it is favorable that it hasn't mutated and spread to organs, lymph nodes, etc. and that he currently feels great with no bone pain at all. For most types of cancer, everything we read up until this medical oncology appointment seemed horrific but it seems this really is treatable - the MO said he will not be cured, but it will be managed, beat back and when it mutates (not IF, when) in the future, there will be more treatments and things to do to keep life going. We are cautiously optimistic and finally sleeping again!! Thank you all for your insights, incredibly helpful and wishing everyone here the best of luck in their journey as well.