Neeraj Agarwal discusses doublet versus triplet selection in metastatic androgen pathway modulation-sensitive prostate cancer. He initiates bicalutamide and ADT immediately at diagnosis, ordering tissue NGS, germline testing, and pre-treatment ctDNA before the first GnRH injection. Indications for triplet therapy in his practice include liver metastases, high-volume symptomatic disease, RB1 loss, and high-degree PTEN loss by IHC, the last because median rPFS with ADT plus abiraterone in PTEN-deficient patients was only 22 to 25 months. Regarding treatment breaks, he references the LIBERTAS trial and the URTC complete discontinuation trial, recommending against unstructured breaks in the absence of severe toxicity until those data mature.

Biographies:

Neeraj Agarwal, MD, FASCO, Professor, Presidential Endowed Chair of Cancer Research, and Director of the GU Program and the Center of Investigational Therapeutics (CIT), Huntsman Cancer Institute, University of Utah, Salt Lake City, UT

Zachary Klaassen, MD, MSc, Urologic Oncologist, Assistant Professor of Surgery/Urology at the Medical College of Georgia at Augusta University, Wellstar MCG, Georgia Cancer Center, Augusta, GA