Advanced castration-resistant prostate cancer (CRPC) is when cancer of the prostate has metastasized, (spread to other parts of the body), despite hormone therapies being given to limit the male hormones, or androgens, in the body. Androgens are commonly known to drive the growth of the cancer cells in the prostate. Therefore, a common first treatment for prostate cancer patients is androgen depletion therapy (ADT). Over time, if the cancer continues to spread outside of the prostate, the disease has developed a castration-resistant disease. If this occurs, patients will require additional treatment.
CRPC is often suspected when prostate cancer patients experience one of the following:
- New symptoms are experienced after ADT is given
- PSA continues to rise during treatment
- Disease not previously found is shown in bone scans or CT scans
Approximately 10-20% of prostate cancer cases are castration-resistant, and up to 16% of these patients show no evidence that the cancer has spread at the time of the castration-resistant diagnosis. This is because, unlike many other cancers, prostate cancer usually progresses very slowly. It can take up to 15 years for the cancer to spread from the prostate to other parts of the body, typically the bones. In some cases, prostate cancer won’t affect a man’s natural life span. For others, especially for metastatic and castration resistant patients, the prognosis is not as favorable.
How is Advanced Castration-Resistant Prostate Cancer Treated?
For these advanced castration-resistant prostate cancer patients, there are several treatment options to consider. Each patient may require different treatments based on their extent of metastasis, symptoms experienced, and overall health. Therefore, you should consult your doctor about which treatments may be the most beneficial for you. For most patients, ADT is usually continued in combination with an additional treatment. The additional treatments can include:
- Targeted therapies
- First-line systemic chemotherapy or second-line systemic chemotherapy
- Systemic corticosteroid therapy, such as low-dose prednisone or dexamethasone
- Secondary hormonal manipulations, such as bicalutamide
- Palliative radiation, such as strontium and samarium
- Bone-targeted therapy, such as zoledronic acid
Because the overall prognosis for this disease is not favorable, clinical trials are important for the development of new treatment options for advanced castration-resistant prostate cancer patients. According to the National Cancer Institute (NCI), “Because CRPC remains an incurable and ultimately fatal illness, participation in clinical trials at all stages of the disease remains paramount.” Clinical trials are researching ways of improving treatment for CRPC patients through both new therapies and new methods of using standard treatments.