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You have accessUrology PracticeResearch Letters1 Jan 2024Reply by Authorsis a reply to letterEditorial Comment Georges Gebrael, Nicolas Sayegh, Nishita Tripathi, Divyam Goel, Taylor McFarland, Hedyeh Ebrahimi, Blake Nordblad, Beverly Chigarira, Vinay Mathew Thomas, Kamal Kant Sahu, Haoran Li, Alexander Chehrazi-Raffle, Manish Kohli, Neeraj Agarwal, Umang Swami, and Benjamin L. Maughan Georges GebraelGeorges Gebrael Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah Co-first authors. More articles by this author , Nicolas SayeghNicolas Sayegh Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah Co-first authors. More articles by this author , Nishita TripathiNishita Tripathi Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah More articles by this author , Divyam GoelDivyam Goel Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah More articles by this author , Taylor McFarlandTaylor McFarland Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah More articles by this author , Hedyeh EbrahimiHedyeh Ebrahimi Division of Medical Oncology, Department of Internal Medicine, City of Hope, Duarte, California More articles by this author , Blake NordbladBlake Nordblad Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah More articles by this author , Beverly ChigariraBeverly Chigarira Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah More articles by this author , Vinay Mathew ThomasVinay Mathew Thomas Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah More articles by this author , Kamal Kant SahuKamal Kant Sahu Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah More articles by this author , Haoran LiHaoran Li Division of Medical Oncology, University of Kansas Cancer Center, Kansas City, Kansas More articles by this author , Alexander Chehrazi-RaffleAlexander Chehrazi-Raffle Division of Medical Oncology, Department of Internal Medicine, City of Hope, Duarte, California More articles by this author , Manish KohliManish Kohli Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah More articles by this author , Neeraj AgarwalNeeraj Agarwal Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah More articles by this author , Umang SwamiUmang Swami *Corresponding Author: Umang Swami, MD, Division of Hematology and Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, 1950 Circle of Hope, KFK 8300.04 SLC, UT 84112 ( E-mail Address: [email protected] Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah Co-senior authors. More articles by this author , and Benjamin L. MaughanBenjamin L. Maughan Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah Co-senior authors. More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000471.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail We acknowledge the insights provided by Drs de Riese and Sharma and agree with their observation. However, we want to emphasize to readers that progression to metastatic castrate-resistant prostate cancer (mCRPC) can still occur without any prior exposure or after a limited duration of exposure to androgen receptor pathway inhibitors (ARPIs). Several scenarios highlight this. Firstly, the most predominant presentation of prostate cancer in the United States is localized prostate cancer, with between 20% and 50% of patients experiencing biochemical recurrence marked by PSA progression after definitive therapy.1 Many of these patients are treated with androgen deprivation therapy (ADT) alone, either intermittently or continuously, until they develop mCRPC. In the second scenario, many patients present with high-risk localized prostate cancer and are treated with radiation therapy and limited-duration ADT with 2 years of abiraterone. Many of these patients continue to have castrate serum testosterone levels until they develop mCRPC. Lastly, the most recent real-world data from 2020 suggest that less than 50% of patients with metastatic castration-sensitive prostate cancer (mCSPC) were treated with an ARPI, while the remainder either pursued ADT monotherapy or received docetaxel as the only intensification agent in the mCSPC setting.2 Additionally, certain patients with mCSPC with remarkable and prolonged responses may discontinue ARPI therapy due to chronic side effects and/or financial constraints. As a result, these patients with mCSPC may not be on active treatment with an ARPI at the time of disease progression to mCRPC. In all these scenarios, the patients remain candidates for treatment with an ARPI at the time of onset of mCRPC. References 1. LBA02-09 EMBARK: a phase 3 randomized study of enzalutamide or placebo plus leuprolide acetate and enzalutamide monotherapy in high-risk biochemically recurrent prostate cancer. J Urol. 2023; 209(suppl 4):e1190. Abstract, Google Scholar 2. . The management of metastatic castrate-sensitive prostate cancer: from guidelines to real-world practice. Oncologist. 2023; 28(9):746-749. Crossref, Medline, Google Scholar © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesUrology Practice30 Oct 2023Editorial Comment Volume 11 Issue 1 January 2024 Page: 36-36 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Metrics Author Information Georges Gebrael Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah Co-first authors. More articles by this author Nicolas Sayegh Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah Co-first authors. More articles by this author Nishita Tripathi Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah More articles by this author Divyam Goel Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah More articles by this author Taylor McFarland Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah More articles by this author Hedyeh Ebrahimi Division of Medical Oncology, Department of Internal Medicine, City of Hope, Duarte, California More articles by this author Blake Nordblad Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah More articles by this author Beverly Chigarira Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah More articles by this author Vinay Mathew Thomas Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah More articles by this author Kamal Kant Sahu Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah More articles by this author Haoran Li Division of Medical Oncology, University of Kansas Cancer Center, Kansas City, Kansas More articles by this author Alexander Chehrazi-Raffle Division of Medical Oncology, Department of Internal Medicine, City of Hope, Duarte, California More articles by this author Manish Kohli Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah More articles by this author Neeraj Agarwal Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah More articles by this author Umang Swami Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah *Corresponding Author: Umang Swami, MD, Division of Hematology and Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, 1950 Circle of Hope, KFK 8300.04 SLC, UT 84112 ( E-mail Address: [email protected] Co-senior authors. More articles by this author Benjamin L. Maughan Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah Co-senior authors. More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...