Optimal Management of Prostate Cancer Based on its Natural Clinical History.
Prostate cancer is the most common malignancy in males and, despite a marked improvement in diagnostic techniques, a not small percentage of prostate tumours is still diagnosed in advanced stage. It is now clear that prostate cancer passes through distinct phases during its natural history, starting from an initial phase, in which the disease has a locoregional extent, until a very late phase when it becomes refractory to hormone therapy. It is important to distinguish between local disease, in which tumor may be considered localized in the gland and a systemic disease characterized by high tumor burden and/or dissemination of circulating tumour cells. All the prostate cancers, at first diagnosis, are characterized by high sensitivity to the androgen deprivation therapy (ADT); however, during the natural history, after a variable period, they become castration resistant. In the past, few therapy options were available for castration resistant prostate cancer, while at present much more approaches can be employed, both hormone-based therapies and chemotherapy regimens. Hypercastration agents are defined as drugs capable to target the androgenandrogen receptor axis even in castrate resistant conditions. Abiraterone and enzalutamide are the only two hypercastration agents available for clinical use. Osteoclast targeted agents, such as zoledronic acid and denosumab can always been employed, but their use should be limited to the castrate resistant setting. The optimal understanding of all phases characterizing the natural history of prostate cancer may certainly be useful for the selection of the best therapeutic options in prostate cancer.
Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy.
Gaetano
G
Facchini
Department of Onco-Ematology Medical Oncology, S.G. Moscati Hospital of Taranto, Taranto, Italy.
Francesco
F
Perri
Department of Biochemistry, Biophysics and General Pathology, Second University of Naples, Italy.
Gabriella
G
Misso
Department of Onco-Ematology Medical Oncology, S.G. Moscati Hospital of Taranto, Taranto, Italy.
Carmine
C
D'Aniello
Department of Onco-Ematology Medical Oncology, S.G. Moscati Hospital of Taranto, Taranto, Italy.
Giuseppina Della Vittoria
GDV
Scarpati
Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy.
Sabrina
S
Rossetti
Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy.
Chiara Della
CD
Pepa
Department of Onco-Ematology Medical Oncology, S.G. Moscati Hospital of Taranto, Taranto, Italy.
Salvatore
S
Pisconti
Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany.
Gerhard
G
Unteregger
Department of Biochemistry, Biophysics and General Pathology, Second University of Naples, Italy.
Alessia
A
Cossu
Department of Biochemistry, Biophysics and General Pathology, Second University of Naples, Italy.
Michele
M
Caraglia
Department of Medical Oncology, National Cancer Institute, Aviano (PN), Italy.
Massimiliano
M
Berretta
Department of Onco-Ematology Medical Oncology, S.G. Moscati Hospital of Taranto, Taranto, Italy.
Carla
C
Cavaliere
D000726:Androgen Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011379:Prognosis; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D011944:Receptors, Androgen / Q000737:chemistry*
C410798:AR protein, human; D000726:Androgen Antagonists; D011944:Receptors, Androgen
Prostate cancer; androgen deprivation therapy; bone metastasis; hypercastration; metastatic castration resistant prostate
cancer; natural history.