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Is there such a thing as 5ARI resistance - especially for metastatic patients?
From my limited research, it seems metastatic patients who employ ADT3 experience a pronounced dip in PSA to as low as 0.01. But in about 7 months the DHT levels spike up to their original levels. As the DHT levels rise the PSA increases. The DHT levels then stabilize to what they should be without Dutaseride. (Also refer to Avias Trial)
This PSA rise is NOT true CRPC because the PSA rise is due to 5ARI resistance. If the majority of cells are still androgen dependent at this point the PSA should stabilize albeit at a higher level.
The result is that people who employ ADT2 would stabilize at the same PSA level as will patients who employ ADT3 but without the "false" dip to very low levels followed by a PSA spike.