[Treatment of the patient with castration-resistant biochemical progression of prostate cancer].
Castration resistant prostatic carcinoma (CRPC) is defined as tumor progression despite an effective castration (serum testosterone levels < 50 ng/dL). Biochemical  progression requires at least two successive increases from the previous lowest value of serum prostate-specific antigen (PSA) spaced at least a week, and with a  minimum  value of 2 ng/mL. In patients receiving complete androgen blockade, antiandrogen should be discontinued prior to diagnosis of CRPC. CPRC is a heterogeneous entity. Baseline PSA and PSA velocity seem to be the most important prognostic factors in patients with biochemical relapse as the only manifestation  of CRPC. Some of these patients can be followed without treatment until disease progression. Because of a large proportion of tumors progressing under androgen deprivation  therapy remain hormone-dependent, the use of other hormonal therapies has been the preferred treatment for the majority of these patients. Besides inhibitors of adrenal  steroidogenesis, other novel hormonal approaches are currently under investigation to avoid the effect of the activated androgenic receptor on the tumor cell. In recent  years there has been an important development of immunotherapy, which has demonstrated to increase survival in CRPC oligosymptomatic patients. First and second line  chemotherapy in CRPC are associated with an increase in overall survival, but they are usually recommended for patients with metastases. Until the results of ongoing  trials are available, the type and timing of the treatment for patients with CRPC and biochemical recurrence should be individualized.
Servicio de Oncología Médica, Hospital General Universitario Gregorio Marañón, Madrid, España. jarranza.oncomed@gmail.com
José Angel Arranz
JA
Arija
Rafael González
RG
Beca
Cristina López
CL
López
Pilar Sabin
PS
Domínguez
Alicia Soria
AS
Lovelle
Yolanda Jerez
YJ
Gilarranz
D000726:Androgen Antagonists / Q000627:therapeutic use; D018450:Disease Progression; D019008:Drug Resistance, Neoplasm; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood* / Q000628:therapy*; D013739:Testosterone / Q000097:blood*; D017211:Treatment Failure
D000726:Androgen Antagonists; D013739:Testosterone; D017430:Prostate-Specific Antigen