Patrick is an 87-year-old male who is diagnosed with malignant neoplasm of prostate (C61), along with Dysuria and rising PSA. Patrick was previously treated with Lupron and a prostatectomy, but still experienced aggressive disease progression. Your denial indicates Patrick is to have metastatic, castration-resistant prostate cancer and to have tried and or failed or have a contraindication to Zytiga before being approved for Xtandi therapy. FDA guidelines does not require Zytiga as a prerequisite for treatment with Xtandi. In addition, Zytiga requires steroid co-administration whereas Xtandi does not as well as Zytiga therapy entails dietary restrictions, whereas Xtandi therapy does not. In the STRIVE study, Xtandi was associated with significantly