Open Access

ARTICLE

The changing landscape of advanced and castration resistant prostate cancer: latest science and revised definitions

Derya Tilki^1,2, Christopher P. Evans¹

1 Department of Urology, University of California, Davis, Medical Center, Sacramento, California, USA
2 Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
Address correspondence to Dr. Christopher P. Evans, Dept of Urology, University of California, Davis, School of Medicine, 4860 Y St., Suite 3500, Sacramento, CA 95817 USA

Canadian Journal of Urology 2014, 21(Suppl.2), 7-13.

Abstract

instruction: Introduction: One fifth of men with newly diagnosed prostate cancer present with locally advanced or metastatic disease. Androgen deprivation therapy (ADT) is the standard systemic therapy in these patients. Despite initial response, essentially all patients will develop castration-resistant prostate cancer (CRPC). In this review, we will discuss the revised definitions of CRPC and the latest understanding of the biology of the androgen/androgen receptor axis in the development of advanced prostate cancer.
instruction: Materials and methods: A systematic literature review was conducted via electronic database articles based on title, abstract, study format, and content. The majority of selected articles were published between 1992 and 2013. Older studies were included selectively if historically relevant.
instruction: Results: Prostate cancer becomes castration-resistant through numerous pathways, including androgen and androgen receptor (AR) dependent mechanisms as well as ligand and AR independent pathways. Therefore the terms androgen-insensitive and hormone-refractory should be avoided and replaced by the term castration-resistant. Recent advances in understanding molecular mechanisms of castration resistance have led to development of novel CRPC therapeutics.
instruction: Conclusions: CRPC remains an incurable disease. Further understanding of the pathways involved in castration resistance will set the basis for development of therapies to increase survival in these patients.

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