Can you/do you use an androgen receptor blocker alone in patients with metastatic hormone-sensitive prostate cancer who cannot tolerate GnRH-directed therapy?

Anti-androgen monotherapy for hormone-sensitive (M0 or M1) prostate cancer is not currently supported by FDA approvals or NCCN/AUA guidelines. Two recent studies that have explored enzalutamide monotherapy in patients with M0 and/or M1 hormone-sensitive prostate cancer are shown below. Enzalutamide ...

I agree with the aforementioned comments that the standard of care for metastatic hormone-sensitive prostate cancer is a GnRH agonist/antagonist typically with a second-generation androgen pathway inhibitor (ARPI) and possibly, chemotherapy (docetaxel). Men should be encouraged to follow this paradi...

I agree with my colleagues. There is a subgroup of patients that either decline or are considered high risk for AE with ADT as long as they are aware of the lack of long-term data. I have discussed enzalutamide monotherapy based on Tombal et al., PMID 25687533 and James et al., PMID 35411939.

The short answer is no. Current standards include lifelong ADT in men with detectable metastases. The full paper on biochemically recurrent prostate cancer (but not in metastatic setting) was just published on October 19th, 2023 online which showed that in patients with prostate cancer with high-ris...

Yes.

I don’t find it rare at all that patients cannot tolerate both and they will stop both. I do monotherapy often preferably with zytiga, but the question was ARPI. So yes, I like Daro. Baby and bathwater.

Although ADT +/- ARSI or abiraterone and maybe Taxotere is the standard of care for M0 and M1 disease. I encourage everyone to listen to their patients! A significant percentage of patients have significant issues with ADT. Many patients have issues that are not easily quantified such as fatigue, sl...