Worried about rising PSA

In 2018 they would not have considered stereotactic RT (SABR) to distant metastasis, but nowadays if there are only a few it is a potential treatment. With an initial diagnosis of advanced prostate cancer it is likely he has too many mets to treat. The scenario that is currently being treated with SABR is people diagnosed without mets, treated with curative intent but who then have a recurrence, imaging may then find a met which can be treated. 

It may be worth asking the oncologist if his 2018 diagnosis would nowadays be considered suitable for SABR? If that were the case then further imaging and SABR might still be on the cards. If he already had multiple mets in 2018 I can't think that further imaging will reveal anything useful.

I think the most likely scenario is to add in another medicine, like enzalutimide.