How would you treat high risk prostate adenocarcinoma who relapsed after RT and ADT with a very low PSA, widespread mets to bone and soft tissue who is progressing on ADT, docetaxel and carboplatin?  

Difficult situation, this patient likely has neuroendocrine differentiation. I would check for markers like NSE, chromogranin if positive, then can make the case of treating as small cell ca progressed on platinum based chemotherapy and treat with lurbinectedin (Trigo et al., PMID 32224306).PSMA bas...