Do you ever consider intermittent ADT for metastatic prostate cancer?

In general, I recommend continuous ADT for men with metastatic disease based on the OS difference from the Intergroup 0162 trial. I do agree, however, that this trial was a noninferiority design and the difference is not large, therefore in men with very limited disease who display intolerance to AD...

Most men with mHSPC deserve a trial of continuous ADT plus further intensification of therapy with a potent AR inhibitor (abi, enza, darolutamide, apalutamide) or docetaxel, and treatment of the primary, all of which provide level 1 survival benefits in certain contexts depending on volume of diseas...