title: Castration-recurrent prostate cancer is not androgen-independent.
abstract: An American man is diagnosed with prostate cancer (PC) every 3 min and dies from the disease every 17 min. Although androgen receptor (AR) expression is diminished following androgen deprivation therapy (ADT) that induces clinical remission in most patients, castration-recurrent PC expresses levels of AR protein similar to those found in androgen-stimulated PC and benign prostate. This observation suggests that the AR may be as important for growth regulation in castration-recurrent PC, as it is in androgen-stimulated PC and benign hyperplasia. Neither ligand-independence, point mutations, glutamine and/or glycine repeat expansion nor amplification have explained AR activation in most cases of castration-recurrent PC. Castration-recurrent PC tissue has levels of testosterone (T) similar to androgen-stimulated benign prostate and levels of dihydrotestosterone (DHT), the most active androgen for AR activation that are approximately 10% of androgen-stimulated benign prostate. These levels of tissue androgens appear capable of activating the AR since prostate-specific antigen (PSA), the classic androgen-regulated gene, is expressed at similar tissue levels in castration-recurrent and androgen-stimulated PC. These startling findings suggest a paradigm shift; PC that recurs during ADT is not androgen-independent.
authors.affiliation: Urologic Oncology, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Mohler
mesh_terms: D000728:Androgens / Q000494:pharmacology*; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000473:pathology; D009376:Neoplasms, Hormone-Dependent / Q000209:etiology* / Q000473:pathology; D009919:Orchiectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D011944:Receptors, Androgen / Q000502:physiology*
chemical_list: D000728:Androgens; D011944:Receptors, Androgen