Taplin ME, Antonarakis ES, Ferrante KJ, et al. - Via a multicenter randomized phase 3 trial of 953 men, researchers screened and characterized AR-V7–positive (AR-V7+) metastatic castration-resistant prostate cancer (mCRPC), and assessed galeterone in comparison with enzalutamide. AR-V7 was correlated with indicators of advanced and high-volume disease at baseline, comprising greater prostate-specific antigen (PSA) level, more bone metastases, docetaxel for hormone-sensitive disease, former first-generation androgen deprivation therapy, and shorter time from diagnosis to registration. Of 73 eligible patients, 38 were randomly allocated to galeterone (n = 19) or enzalutamide (n = 19). Owing to high censorship for the radiographic progression-free survival events, the data monitoring committee suggested early closure on the basis of interim evidence that the primary endpoint would not be reached. For galeterone and enzalutamide, the PSA50 values were 2/16 (13%) and 8/19 (42%), respectively. Therefore, in the first-line mCRPC, the prevalence of circulating tumor cells messenger RNA AR-V7 was 8%. AR-V7+ was correlated with the features of aggressive and advanced disease. Rapid disease progression was noted in these men. The evolution of galeterone would not be continued.