“We found in ARCHES that in the men who developed radiographic progression while on ADT-enzalutamide [Xtandi], two thirds of these patients, when they had radiographic progression, did not meet PSA progression criteria, and one third didn't have any rise at all in their PSA,” says Andrew J. Armstrong, MD, MSc."
Imaging becomes important when PSA becomes unreliable.
The NHS does have a tendency to follow only PSA so you need to insist on a scan every 6 months regardless of PSA. My experience is they will do it if you ask for it.
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