Progressive mCRPC with bone metastases, what now? (re-vote)

Man, currently 74 years old, earlier diagnosed with high-risk PCa (cT3N0M0; ISUP grade 4; PSA 18 ng/ml). He was treated with EBRT + 24 months ADT. His PSA nadir was 0.7 ng/ml.

2 years after completion of ADT:

• PSA: 3.1 ng/ml
• Testosterone: 312 ng/dl (10.8 nmol/l)
• CT scan: 2 enlarged pelvic lymph nodes
• Bone scan: negative

ADT was started again. PSA nadir was 0.9 ng/ml.

18 months after start of ADT:

• Medical history: well-controlled hypertension
• Asymptomatic
• ECOG PS: 0, G8 score: 15/17
• PSA: 24.2 ng/ml
• Serum testosterone: 12 ng/dl (0.42 nmol/l)
• Bone scan: 8 bone metastases (5 on vertebrae, 2 on the pelvis, 1 on the left femur) that were not present on scans 6 months ago
• CT scan: stable lymph nodes, no signs of visceral metastasis
• No germline or somatic mutations identified

Treatment with denosumab was started.