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Can abiraterone or enzalutamide be substituted for bicalutamide to prevent a flare when initiating ADT with a GnRH agonist for metastatic prostate cancer?

1 Answer
Mednet MemberInvited Expert
Medical Oncology · UTSouthwestern Medical Center
Answered on

In theory, abiraterone or enzalutamide could potentially help by the mechanism to prevent or abrogate the testosterone flare when starting on GnRH agonists. In practice, however, abiraterone and enzalutamide are more difficult to obtain, need to be dispensed at specialty pharmacies, and require prior authorizations -- so practically, bicalutamide is much easier to prescribe/obtain for the 2-4 week testosterone surge after a GnRH agonist is given.