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KMID : 1001020130110010011
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Journal of Urologic Oncology
2013 Volume.11 No. 1 p.11 ~ p.16
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Non-Metastatic Castration-Resistant Prostate Cancer
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Kwon Taek-Min
Jeong In-Gab
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Abstract
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Most men with advanced prostate cancer respond to various types of androgen ablation but eventually progress to castration-resistant prostate cancer (CRPC). However, many patients will have an increase in prostate specific antigen (PSA) on hormonal therapy without radiographic evidence of disease. For this reason, heterogeneous population of non-metastatic CRPC (non-mCRPC) has appeared. To date, PSA kinetics is the most powerful indicator of aggressiveness in that population and can be used to trigger imaging investigation and enrollment in clinical trials. Although CRPC remains largely driven by the androgen receptor, the benefit of second-line hormonal manipulations, including first generation antiandrogens, adrenal synthesis inhibitors and steroids, is clearly limited. Several registered and near to come treatments have not been tested in that population but in men with more advanced metastatic and often symptomatic disease. Several agents have been investigated to delay the onset of the first bone metastasis but only one, denosumab, has reached its end-point. But, overall survival did not differ. Physicians should recognize that non-mCRPC is an extremely heterogeneous stage of the disease, with most patients progressing slowly to a metastatic stage and acknowledge that the available registered treatments have been studied in far more advanced stage of the disease
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KEYWORD
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Prostatic neoplasm, Castration, Androgens, Neoplasm metastasis
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