How do you manage a patient with metastatic prostate cancer who does not acheive a PSA response to upfront ADT?  

First and foremost, of course, confirmation that androgen deprivation (ie testosterone <50 ng/dl) has been achieved should be obtained. While uncommon, primary resistance to a particular hormonal agent can occur. In this case, an alternate agent can be tried (eg switching from an LHRH-R agonist t...