Do you treat de novo metastatic hormone sensitive prostate cancer presenting with a paraneoplastic syndrome more aggressively?  

For these patients, I will likely add a GnRH antagonist early on to drop testosterone quickly. Depending on performance status and other patient characteristics, we still go through the discussion of adding docetaxel, abiraterone, enzalutamide, and apalutamide (I generally add about 3-4 weeks after ...