What alternative therapies would you consider for a patient with metastatic castration-sensitive prostate cancer who declines GnRH analogues?   

This situation is fairly uncommon, particularly in the metastatic setting, where these therapies are nearly universally effective and toxicities generally manageable. The alternatives of bicalutamide at high dose (150 mg/d) and enzalutamide also have toxicities and much less evidence to support thei...