If someone becomes castrate resistant to ADT, then the ARSI’S do work. Once they become resistant to the ASRI It’s possible that they could switch to the other type of ARSI (Abbie to a ludamite, Or the other way around). Unfortunately, this doesn’t work well in most cases.

The PARP Inhibitor only works well with people with BRCA. They think that maybe people with ATM might get some benefit, But it’s not as helpful as those with the BRCA.

Once you have failed ADT and ARSI Then using SBRT to zap metastasis Can work if there aren’t too many. At that point you will need to go to chemotherapy or Pluvicto.

They are working on a drug that can be used once those two Treatments fail, But it is still in early development.

What they told me is that even after a critical mass of the cancer cells evolved castrate resistance, there will still be many that are castrate-sensitive, and they will continue to respond to ADT and ARSI.

If I recall correctly, in the TITAN study, even subjects who did eventually evolve castrate resistance still had slower progression and longer overall survival while taking the ARSI.