How would you approach a patient with M0 castrate-resistant prostate cancer started on enzalutamide who continues to have increasing PSA levels without metastases seen on imaging?
NCCN recommends to change therapy or maintain current therapy in this setting without further clarification. What thresholds would cause a change in treatment if imaging remains negative? Would you consider PSADT?
Answer from: Medical Oncologist at Academic Institution
This is an important question, given the new FDA approvals and NCCN guidelines in the M0 CRPC treatment space and likely increased use of apalutamide and enzalutamide in these men with PSA-only CRPC. In general, these studies continued treatment until metastatic progression (soft tissue or bon...
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