Castration-resistant prostate cancer (CRPC) is disease progression despite chemical castration, indicated by rising levels of prostate-specific antigen (PSA). Patients with metastatic castration-resistant prostate cancer (mCRPC) have a poor prognosis with survival rate of less than 2 years. Prostate cancer preferentially metastasizes to bone.As the disease transits from castration sensitive to castration resistant, the incidence of bone metastasis increases, with more than 90% of patients with mCRPC developing bone metastases. Symptomatic patients with mCRPC are at high risk for spontaneous fracture and spinal cord compression, causing significant pain and poor quality of life. A paucity of therapeutic options is available for mCRPC. But, recent developments in our understanding of the disease have resulted in several new therapies that show promise in improving overall survival rates.
Agents generally use in India and those undergoing clinical trials for the treatment of mCRPC were reviewed. Recent contributions to the understanding of prostate biology and bone metastasis were discussed as well as how the underlying mechanisms may represent opportunities for therapeutic intervention. New drugs with various combinations were tried on 980 patients in last 3years.
New and emerging treatments that target androgen synthesis (Abiraterone acetate), Taxane-derived chemotherapies (Docetaxel & Cabazitaxel) and targeting the genetically stable host microenvironment to make mCRPC more visible to cytotoxic T cells (Sipulecuel-T) improves overall survival rates. Determining how factors derived from the primary tumor can promote the development of premetastatic niches and how prostate cancer cells parasitize niches in the bone microenvironment, thus remaining dormant and protected from systemic therapy, could yield new therapies to treat mCRPC.
The emergence of novel treatments for mCRPC, combined with improved patient stratification and optimized therapy sequencing, suggests that significant gains may be made in terms of overall survival rates for men diagnosed with this form of cancer.
Clinical trial identification
All authors have declared no conflicts of interest.