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Prostate Cancer | Last Active: 3 days ago | Replies (47)
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The cancer cells may or may not evolve to become castrate resistant, depending on how fully they're repressed. The trouble is that there is no medical way to detect if there are still some dormant cancer cells or micrometastases, waiting to start growing again some day.
ADT buys you time, and ARSIs like Apalutamide extend that time significantly for many prostate cancer patients. Radiation therapy also buys time (as does chemo, in the cast of polymetastatic PCa). They add up.
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Yes, it seems the only way to know whether other cancer cells will come out of dormancy is to stop therapy or if they become castrate resistant during ADT and the PSA rises with their growth. I'm inclined to take ADT for one year, then switch to Darolutamide for six months. If PSA is acceptably low at that point, take a therapy holiday. If PSA begins to rise with Darolutamide, add ADT back in and ask for a scan to determine whether spot radiation might eliminate whatever's still there.