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Progression of metastatic castration-resistant prostate cancer (mCRPC) is manifested as clinical progression (pain, skeletalrelated events, and other symptoms), radiological progression, or increases in prostate-specific antigen (PSA) of 25% or more and absolute increases of 2 ng/mL or more from the nadir.1 PSA flare occurs when there is an initial PSA increase of more than 25% after the initiation of therapy, followed by a PSA decrease of at least 75% compared to the maximum increase over baseline.2 Antiandrogen withdrawal syndrome describes the phenomenon of a drop in PSA with or without clinical improvement, following the withdrawal of androgen receptor (AR) inhibitors or steroids.3 This presentation featured case studies of one patient with antiandrogen withdrawal syndrome and two other patients with PSA flare. All three patients were treated with abiraterone. The PSA responses from diagnosis and throughout treatment of the three patients are captured in Fig. 1.

Withdrawal syndrome and PSA flare in the management of mCRPC with abiraterone