Korean J Urol.  2014 Mar;55(3):153-160. 10.4111/kju.2014.55.3.153.

Nonmetastatic Castration-Resistant Prostate Cancer

• Hong JH
• Kim IY

• KMID: 1988417
• DOI: http://doi.org/10.4111/kju.2014.55.3.153

Abstract

After the introduction of prostate cancer screening with the prostate-specific antigen (PSA) test, we have witnessed a dramatic stage migration. As a result, an increasing number of patients are diagnosed at earlier stages and receive local treatments including surgery or radiation. When these local treatments fail by the definition of increasing PSA levels, patients are usually treated with androgen-deprivation therapy. A fraction of these patients will finally reach a state of castration-resistant prostate cancer (CRPC) even without radiological evidence of metastasis, which is referred to as nonmetastatic CRPC (NM-CRPC). Most men with advanced or metastatic prostate cancer initially respond to various types of androgen ablation, but a considerable portion of them eventually progress to NM-CRPC. Among patients with NM-CPRC, about one-third will develop bone metastasis within 2 years. In these patients, PSA kinetics is the most powerful indicator of progression and is usually used to trigger further imaging studies 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, has not been investigated in men with NM-CRPC. To date, denosumab is the only agent that has been shown to delay the onset of bone metastasis. However, overall survival did not differ. In treating NM-CRPC patients, physicians should recognize the heterogeneity of the disease and acknowledge that the recently approved second-line treatments have been studied only in advanced stages of the disease.

Keyword

Castration-resistant prostatic neoplasm; Neoplasm metastasis; Prostate-specific antigen

MeSH Terms

Androgen Antagonists
Humans
Kinetics
Male
Mass Screening
Neoplasm Metastasis
Population Characteristics
Prostate*
Prostate-Specific Antigen
Prostatic Neoplasms*
Prostatic Neoplasms, Castration-Resistant
Receptors, Androgen
Steroids
Androgen Antagonists
Prostate-Specific Antigen
Receptors, Androgen
Steroids

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