Anti-neoplastic drugs — MCQs

A 70-year-old man with metastatic castration-resistant prostate cancer has rising PSA despite enzalutamide therapy. Imaging shows new bone metastases but no visceral disease. He has a history of well-controlled seizures on levetiracetam, type 2 diabetes on metformin, and stage 3 chronic kidney disease (eGFR 42 mL/min). Genetic testing shows BRCA2 germline mutation and homologous recombination deficiency. The oncologist considers four treatment options: docetaxel chemotherapy, radium-223, olaparib, or lutetium-177-PSMA. Synthesize the clinical data and evaluate the optimal treatment considering efficacy, mechanism, and patient-specific factors.