How would you approach second line treatment for prostate adenocarcinoma with diffuse neuroendocrine features?

Men with NEPC (histologic evidence of small cell carcinoma) face a poor prognosis and are typically refractory to all hormonal interventions, and in fact transformed NEPC much more typically evolves after potent AR inhibition than present de novo at diagnosis. Autopsy series and biopsy series suggest that about 15-18% of men in the post -AR therapy mCRPC setting will have transformed NEPC with loss of AR dependence, irrespective of the pattern of spread (node, bone, visceral patterns), suggestin...