Studies in patients with metastatic prostate cancer have shown that flares peak on bone scintigraphy 6 to 8 weeks after treatment22,23, and as a result of this, the Prostate Cancer Working Group 2 (PCWG2) do not recommend any immediate changes to treatment if there is an increase in bone accumulation using scintigraphy, or an increase in PSA levels within 12 weeks of treatment initiation24. This evidence concerns the gene KLK3 and prostate carcinoma.