Can abiraterone or enzalutamide be substituted for bicalutamide to prevent a flare when initiating ADT with a GnRH agonist for metastatic prostate cancer?  

In theory, abiraterone or enzalutamide could potentially help by the mechanism to prevent or abrogate the testosterone flare when starting on GnRH agonists. In practice, however, abiraterone and enzalutamide are more difficult to obtain, need to be dispensed at specialty pharmacies, and require prio...