Metastatic castration-resistant prostate cancer

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Synonyms

mCRPC,

Overview

Castration-resistant prostate cancer (CRPC) is a form of
advanced prostate cancer. With CRPC, the cancer no longer
completely responds to treatments that lower testosterone.
It shows signs of growth, like a rising PSA (prostate-specific
antigen), even with low levels of testosterone.
With Metastatic CRPC (mCRPC), the cancer stops
responding to hormone treatment, and it is found in other
parts of the body. It can spread to nearby lymph nodes,
bones, the bladder, rectum, liver, lungs, and maybe the
brain.

Symptoms

There may be no signs or symptoms at all. If there are
symptoms from mCRPC, they depend on the size of the
tumors and where the cancer has spread.
Signs of mCRPC may begin with:

• Trouble urinating
• Pain or blood in urine

• Feeling more tired or weak than normal
• Weight loss
• Shortness of breath
• Bone pain

Treatment

The main goal for treating mCRPC is to control symptoms
and slow progress. Even though androgen deprivation
therapy (ADT) or hormone therapy may no longer work
completely to stop prostate cancer from growing, most
men with mCRPC remain on ADT because some prostate
cancer cells will continue to respond to it. Other cells need
additional treatment to keep the cells from forming. More
treatments are added, like:

Chemotherapy like docetaxel and cabazitaxel. These
chemotherapies are drugs that may help extend how
long men can live with mCRPC. Cabazitaxel is given with
the steroid prednisone, and is an option when docetaxel
doesn’t help.

• Immunotherapy like sipuleucel-T. This treatment takes
your immune cells and helps them fight cancer cells. It is
mainly used with men who have few or no symptoms.

• Second-line hormone therapies like abiraterone and
enzalutamide. These target male hormones in different
ways than first-line ADT. These oral drugs can extend life.

• Radioactive material like Xofigo (radium-223 dichloride).
This is treatment is used to attack cancer cells in bones.

• Clinical trials are research studies to test new treatments
or learn how to use existing treatments better, or in
combination.

• Active surveillance is a way to track cancer growth and
used to avoid aggressive therapy.

• Gene Therapy includes medication options that may
be helpful for some patients whose tumors show certain
genetic mutations. These mutations are found through a
process called genomic sequencing of the cancer.

Treatments to help with symptoms are also added, like:

• Bone-targeted therapy to help prevent or manage
bone pain, fractures or other bone problems. Medicines,
radiation or vitamins (calcium and/or vitamin D) are used.
• External radiation is used to kill tumors. It can help with
pain and other symptoms if prostate cancer spreads to the
bones.