What is your preferred treatment approach for a patient who has prostate cancer with disease only in retroperitoneal nodes, experiencing rapid biochemical progression on abiraterone, and who was previously treated with an androgen receptor inhibitor while non-metastatic?

I would consider a non hormonal option for this patient. I advise germline/somatic testing to evaluate for DNA repair mutations that are present in 15-20% of the patients. If these are present, it identifies PARP inhibitor as an option. Rarely next generation sequencing may identify MSI-high disease...