title: Expert opinion on first-line therapy in the treatment of castration-resistant prostate cancer.
abstract: Treatment of metastatic castration-resistant prostate cancer (mCRPC) has been revolutionized in recent years. It is well known that androgen receptor is still active in most patients with disease progression and serum testosterone levels <50 ng/dL. Moreover, further hormonal maneuvers, either through decreasing androgen levels (abiraterone) or by targeting the androgen receptor (AR) pathway (enzalutamide), prolong survival. In addition, a new cytostatic able to overcome docetaxel resistance, cabazitaxel, and the radioisotope radium 223 have been incorporated to the armamentarium of mCRPC. mCRPC is not only a heterogeneous tumor, it changes over time developing neuroendocrine features or selection of clones resistant to hormonal maneuvers. In addition, the multiplicity of current treatments, make it necessary to design algorithms that help the specialist to choose the most appropriate treatment for a particular patient. The lack of randomized trials comparing face to face the different available options limit the scope of this review. In this article, the authors describe the prognostic factors for first line therapy in patients with mCRPC, and propose a treatment algorithm for mCRPC based on the levels of scientific evidence available and, if not available, on the consensus between medical professionals. Finally, the panel discuss how to define progressive disease in the setting of mCRPC and treatment with targeted therapies.
authors.affiliation: Department of Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Electronic address: jmaroto@santpau.cat.
authors.forename: Pablo
authors.initials: P
authors.lastname: Maroto
authors.affiliation: Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Solsona
authors.affiliation: Department of Oncology, Parc Taulí Sabadell Hospital Universitari, Sabadell, Barcelona, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Gallardo
authors.affiliation: Department of Medical Oncology, Hospital Clínic, Barcelona, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Mellado
authors.affiliation: Department of Urology, Hospital Vall d́Hebrón, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Morote
authors.affiliation: Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: José Ángel
authors.initials: JÁ
authors.lastname: Arranz
authors.affiliation: Department of Urology, Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Gómez-Veiga
authors.affiliation: Department of Urology, Hospital de Basurto, Bilbao, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Unda
authors.affiliation: Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Climent
authors.affiliation: Department of Urology, Hospital Clínic, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Alcaraz
mesh_terms: D000465:Algorithms; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018450:Disease Progression; D019008:Drug Resistance, Neoplasm; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy / Q000379:methods* / Q000592:standards; D011379:Prognosis; D064129:Prostatic Neoplasms, Castration-Resistant / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*
keywords: Algorithm; Cabazitaxel; Castration-resistant prostate cancer; Consensus; Hormone therapy; Prognostic factors