Doubts about systemic treatments

Just 10 years ago when I came to the Forum it was relatively rare to see men on ADT who went much more than three years or so before castrate resistance. Probably the single greatest reason for significantly improved outcomes has been the drug trials that proved giving ADT + ARPIs (Xtandi, Zytiga, etc) given together with ADT from the start works much, much better than waiting until resistance to add an ARPI.

The clever PCa cells can adapt by over-expressing the androgen receptor to “catch” any remaining T from ADT. ARPIs further reduce the available T, so men live much longer. But alas, PCa eventually makes it past this also.

I am convinced that bipolar androgen therapy has a good chance of becoming a SOC that will further increase men’s lives.

I would second mattam’s views above about where we are now in terms of systemic treatment… Bill