Very true, and with metastatic PCa our main goal is to keep the cancer from spreading into new places. My oncologist told me that much of the cancer remains castrate-sensitive even after some of it evolves castrate resistance, so, as @jeffmarc wrote, continuing on ADT and ARSI still makes sense in many/most cases to slow things down.

Hi @jeffmarc . I didn't say it no longer needs testosterone. What I said it doesn't need YOUR testosterone. The way my oncologist explained it was that the cancer evolves to a point where it makes its own small amount. ZYTIGA® works by interrupting the androgen-making process at an important step. It inhibits androgen at 3 sources—the testes, the adrenal glands, AND the tumor itself. This is the difference from other ADT therapies.