title: Resistance to Hormonal Therapy in Prostate Cancer.
abstract: Several therapeutic strategies are actually available in the management of prostate cancer: Targeting the androgen receptor (AR) is the goal both for initial androgen deprivation therapy (ADT) and second-generation androgen ablative agents (abiraterone and enzalutamide). Chemotherapy with taxanes, administered upon progression or as first line approach in association with ADT, is another therapeutic option. Unfortunately, none of these therapies is curative and patients are destined to develop a resistant phenotype.Progression to ADT leads to the attainment of a castration resistant disease whose mechanisms remain incompletely understood. Reactivation of AR has been shown to occur and second-generation of AR targeting drugs are usually prescribed. Upon progression to these agents AR signaling still remains the primary driver although it often becomes ligand independent, since it can be either restored through mutations on the ligand binding domain and/or formation of AR splicing variants or by passed through a cross talk with other oncogenic signaling pathways.AR-independent signaling pathways may represent additional mechanisms underlying castration resistant progression. It is clear that castration resistant prostate cancer is a group of diverse diseases and new treatment paradigms need to be developed.
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia at ASST-Spedali Civili, Brescia, Italy. alfredo.berruti@gmail.com.|Oncologia Medica, ASST-Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, Italy. alfredo.berruti@gmail.com.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Berruti
authors.affiliation: Department of Oncology, Verona Comprehensive Cancer Network, G.B. Rossi Hospital, University of Verona, Piazzale L. A. Scuro 10, 37134, Verona, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Dalla Volta
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use*; D059002:Androgen Receptor Antagonists / Q000627:therapeutic use*; D018450:Disease Progression; D019008:Drug Resistance, Neoplasm; D006801:Humans; D008297:Male; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy*; D011944:Receptors, Androgen; D015398:Signal Transduction
chemical_list: D000726:Androgen Antagonists; D059002:Androgen Receptor Antagonists; D011944:Receptors, Androgen
keywords: Androgen receptor splice variant; Castration resistant prostate cancer; Endocrine therapy resistance