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A new diagnosis of metastatic prostate cancer is life-altering.  Deciding on the treatment, used to be straightforward, it’s not anymore. After addressing this issue with patients for many years, and staying abreast of the latest developments, I describe an approach to starting treatment in five questions for both the patient
Ever since they were introduced, the question of the efficacy of a combined approach with abiraterone and enzalutamide has been questioned.  We are now getting to the point of seeing the results of these approaches and a window into how similar, or distinct, these two therapies are.
I quip sometimes when lecturing that a clinician will make their first decision to use a new therapy based on the data - but the second time they make the decision to use that therapy it will be based on their experience. Although obviously a gross oversimplification,  I think it does reflect the fact that we obtain biases as we treat patients. 
The standard of care for castration-resistant prostate cancer (CRPC) has changed so much in the past decade that it is sometimes hard to keep up with what might be coming down the pipeline. The TROPIC Study, when it became public back in about 2011, was a complete surprise to me. The first I heard of the study was when the trial reported out the survival data and almost
Hormonal signaling is an intriguing process with a lot of redundancy, promiscuity and feedback. Androgen metabolism is particularly complicated and likely reflects the absolute necessity of intact hormonal signaling for mammalian evolution. I have spent over 15 years studying many aspects of prostate cancer but probably the two most prominent facets of my research life relate to the development of treatments like abiraterone for mCRPC but also the study of the measure of hormones, their signaling patterns and its relationship to outcome in CRPC.
The age of tumor sequencing is here. Does it help? Earlier this year a paper in JAMA oncology permitted us to begin to ask that question aloud. Oncology has doubled down on the promise that cancer therapy decisions are going to be personalized. That promise has been made to the public, professorships have been established and whole
A meditation on the need and utility for Sip T in 2018. On a nearly weekly basis I am confronted by the question of whether I should be giving a patient Sipuleucel T. I still use it, but not in all my CRPC patients, and I like to think of this therapy as having a reasonable benefit for patients - who are at an early point in the CRPC spectrum. I will explain but first let’s review the data and its limitations.

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