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I think that might be overstating the problem a bit. There's no test for individual cancer cells loose in the body, period — they can't detect them until they start forming tumors — so there would be no way with current tech to detect if some of those cells are evolving castrate resistance.
But they can measure by impact. Prostate cancer cells express PSA when they're multiplying, so if ADT brings your PSA down, then at least a lot of your cancer is castrate sensitive; if it doesn't, then at least a significant portion of it is evolving castrate resistance.
Replies to "I think that might be overstating the problem a bit. There's no test for individual cancer..."
I should have been more clear - I meant testing the biopsies for mutations and anomalies - we just got ‘adenocarcinoma of prostate origin’ from the lung Mets - I mean, isn’t there more information in that cluster?
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Agreed…. I think the universal assumption that all PCa initially is hormone dependent is the quickest, EASIEST path forward for the patient.
Although no one likes the SE’s of ADT, it works quickly - (can anyone cite ONE case where PSA went UP or stayed the same after initiating ADT?) and has far fewer side effects than the treatments used for castrate resistance.
But of course we all want to think “ours is different”. Best
Phil