Overview of the treatment of castration-resistant prostate cancer (CRPC)
- Nancy A Dawson, MD
Nancy A Dawson, MD
- Professor of Medicine
- Lombardi Comprehensive Cancer Center
- Georgetown University
- Section Editors
- Nicholas Vogelzang, MD
Nicholas Vogelzang, MD
- Section Editor — Prostate Cancer
- Professor of Medicine
- University of Nevada School of Medicine
- US Oncology Research
- W Robert Lee, MD, MS, MEd
W Robert Lee, MD, MS, MEd
- Section Editor — Prostate Cancer
- Professor of Radiation Oncology
- Duke University Medical Center
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
Although most cases of prostate cancer are diagnosed and treated while disease is localized, some men have evidence of metastatic prostate cancer at presentation, and others develop disseminated disease after their definitive treatment.
Contemporary research has led to the development of multiple active treatment modalities for men with advanced disease, in addition to androgen deprivation therapy (ADT). Management of men with castration-resistant prostate cancer (CRPC) involves the sequential use of these approaches, with the goals of prolonging survival, minimizing complications, and maintaining quality of life.
Treatment options for patients with CRPC and the proper sequencing of the approaches are presented here.
The management of men with castration-sensitive prostate cancer is discussed separately. (See "Overview of the treatment of disseminated castration-sensitive prostate cancer".)
In many cases, the only manifestation of disseminated disease is an elevated or rising serum prostate-specific antigen (PSA) following definitive local radiation therapy (RT; or surgery). However, some men with prostate cancer have overt metastases either at presentation or as their first sign of recurrence following definitive therapy. In the vast majority of cases, such metastases are predominantly osteoblastic lesions in the axial skeleton; such metastases may vary from asymptomatic to symptomatic.
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- PATIENT POPULATIONS
- CASTRATION RESISTANCE
- Continuation of ADT
- SYSTEMIC THERAPY OPTIONS
- INTERFERENCE WITH ANDROGENIC STIMULATION
- Other endocrine approaches
- - First-generation antiandrogens
- - Antiandrogen withdrawal
- - Ketoconazole
- - Glucocorticoids
- - Estrogens and progesterones
- ASSESSMENT DURING TREATMENT
- PROGNOSTIC FACTORS
- Clinical parameters in castration-resistant disease
- Prognostic biomarkers
- - Circulating tumor cells
- - Markers of bone metabolism
- - Gene expression panels
- NEUROENDOCRINE CARCINOMA OF THE PROSTATE
- BONE METASTASES
- Radiation therapy
- Osteoclast inhibition
- SYMPTOMATIC PELVIC DISEASE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS