New therapeutic approaches in the management of castration resistan prostate cancer

Ioannis Gkialas


Building on decades of research, the past few years have yielded a near exponential increase in treatment modalities for patients with metastatic prostate cancer.  Individually, these improvements in overall survival may appear modest, however, nearly all of them have a distinct mechanism of action and the possibility of synergistic effects have yet to be established. The promise of a durable impact on the mortality from metastatic prostate cancer will likely stem from further elucidation of molecular pathways involved in prostate cancer, as well as defining the optimal sequence of treatment for patients with metastatic prostate cancer.

Η ανάπτυξη των νέων προσεγγίσεων στη διαχείριση του προχωρημένου μεταστατικού καρκίνου του προστάτη έχει σημειώσει μεγάλη πρόοδο τα τελευταία χρόνια.Οι βασικές θεραπείες στέρησης ανδρογόνων (ADT) έχουν τελειοποιηθεί και πολλοί νέοι παράγοντες έχουν εγκριθεί από το 2010 για τη θεραπεία τόσο του μεταστατικού όσο και του ευνουχοάντοχου καρκίνου του προστάτη (mCRPC). Η κατανόηση της θεωρίας αυτών των νέων παραγόντων και η εστιασμένη προσεγγισή τους σε πρακτικές κλινικές εφαρμογές είναι απαραίτητες για τη βελτίωση των θεραπευτικών αποτελεσμάτων. Καθώς η αντιμετώπιση αυτών των ασθενών με προχωρημένη νόσο γίνεται πλέον πολυδιάστατη και η χρήση αυτών των παραγόντων επεκτείνεται, σε ουρολόγους, ογκολόγους και ακτινοθεραπευτές θα πρέπει ολοι να γίνουν πιο εξοικειωμένοι με τις νέες θεραπευτικές επιλογές.



prostate cancer; castration resistant; therapy;προστατικός καρκίνος ευνουχο άντοχος; θεραπεία

Full Text:



Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin 2014; 64(1): 9 - 29.

Heidenreich A, Pfister D., Merseburger A, Bartsch G. Castration - resistant prostate cancer: where we stand in 2013 and what urologists should know. Eur Urol, 2013;64:260 - 5.

Zaorsky NG, Trabulsi EJ, Lin J, Den RB. Multimodality therapy for patients with high - risk prostate cancer: current status and future directions. Semin Oncol 2013; 40(3): 308 - 321.

Niraula S, Le LW, Tannock IF. Treatment of prostate cancer with intermittent versus continuous androgen deprivation: a systematic review of randomized trials. J Clin Oncol2013;31 (16): 2029 - 2036.

Scher HI, Sawyers CL. Biology of progressive, castration - resistant prostate cancer: directed therapies targeting the androgen - receptor signaling axis. J Clin Oncol2005; 23(32): 8253 - 8261.

Knudsen KE, Penning TM. Partners in crime: deregulation of AR activity and androgen synthesis in prostate cancer. Trends Endocrinol Metab2010;21 (5): 315 - 3124.

de Bono JS, Logothetis CJ, Molina A et al. Abiraterone and increased survival in metastatic prostate cancer. N Engl J Med2011; 364(21): 1995 - 2005.

Ryan CJ, Smith MR, de Bono JS et al. Abiraterone in metastatic prostate cancer without previous chemotherapy. N Engl J Med2013; 368(2): 138 - 148

Scher HI, Fizazi K, Saad F et al. Increased survival with enzalutamide in prostate cancer after chemotherapy. N Engl J Med2012; 367(13): 1187 - 1197.

Pound CR, Partin AW, Eisenberger MA et al. Νatural history of progression after PSA elevation following radical prostatectomy. JAMA1999; 281(17): 1591 - 1597.

Pezaro C, Omlin A, Lorente D, de Bono J. Management of patients with castration - resistant disease. Hematol Oncol Clin North Am2013; 27(6): 1243 - 1260

Kantoff PW, Higano CS, Shore nD et al. Sipuleucel - T immunotherapy for castration - resistant prostate cancer. N Engl J Med2010; 363 (5): 411 - 422.

Forti G, Salerno R, Moneti G et al. Three - month treatment with a long - acting gonadotropin - releasing hormone agonist of patients with benign prostatic hyperplasia: effects on tissue androgen concentration, 5 alpha - reductase activity and androgen receptor content.J Clin Endocrinol Metab 1989; 68(2): 461 - 468.

Mohler JL, Gregory CW, Ford OH 3rd et al. The androgen axis in recurrent prostate cancer. Clin Cancer Res2004;10(2): 440 - 448

Attard G, Reid AH, Auchus RJ et al. Clinical and biochemical consequences of CYP17A1 inhibition with abiraterone given with and without exogenous glucocorticoids in castrate men with advanced prostate cancer. J Clin Endocrinol Metab2012; 97 (2): 507 - 516