For patients who progress to mCRPC on ADT+ARSI started in mCSPC setting, do you continue the ARSI if patients have had a mixed response?

A "mixed response" can mean many things and the specific circumstances are critical for decision-making here. For example, bone scan flare, or pseudoprogression, with new unconfirmed lesions, is quite common with ADT/ARSI therapy and should not be a reason for treatment discontinuation as per PCWG2/3 guidelines, and confirmatory bone scans are recommended over time. Soft tissue progression in the setting of response in other soft tissues is unexpected and would reflect a true mixed response. If the soft tissue progression is subtle (i.e. <5 mm growth) in an otherwise asymptomatic patient with declining PSA, treatment continuation is reasonable. If the soft tissue progression is more obvious or symptomatic, then options include switching sys...