How do you approach a patient with a non-castrate testosterone level and rising PSA despite receiving LHRH agonist therapy?

This is a good question. It is always good to check on the testosterone value in men on LHRH agonist therapy in order to ensure the level truly is within castrate range. I assume this patient has been on therapy for a number of months (i.e. the testosterone has had time for full suppression). If so, then you may consider changing LHRH agents to either an antagonist, or a different agonist. If you still have difficulties with suppression, you could consider surgical orchiectomy or adding in an androgen receptor blockade agent.

There are a number of data suggesting the prognostic and predictive value of baseline testosterone values - and we have learned more and more that incomplete suppression of testosterone is a likely driver of poor response to novel lines of therapy.