The answer is sipuleucel-T.
The current definition of castration resistant prostate cancer consists of a testosterone level less than 50ng/dL PLUS either a rise in PSA level, new evidence of disease, or worsening of current disease despite ADT. Currently, the landscape for metastatic castrate resistant prostate cancer has exploded to include several options such as: sipuleucel-T, docetaxel, abiraterone, enzalutamide, and cabazitaxel.
Selection of these agents largely depends on if the patient has metastatic visceral/symptomatic disease. In addition, the newly approved agents currently are indicated in the post-docetaxel setting. In the above patient, sipuleucel-T is indicated. This recommendation is based on the fact that the patient has progressing disease as reflected by a rise in PSA level despite being on ADT therapy. In addition, given that the patient is minimally symptomatic as reflected by acetaminophen controlling his pain rather than narcotics, immunotherapy with sipuleucel-T is considered a category 1 recommendation by the NCCN.
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