How do you approach non-metastatic castration-resistant prostate cancer?

The two recent placebo controlled trials comparing apalutamide and enzalutamide in M0CRPC (SPARTAN and PROSPER) have shown sizeable and consistent effects on various outcome measures, clearly met the primary study endpoints and hence satisfied FDA regulatory criteria for drug approval in this space....

Would use older drugs like nilutamide. Better imaging studies in the future may allow us to detect metastases sooner. Drugs like enzalutamide and abiraterone not approved for this indication and maybe challenging to get insurance to approve