Many patients with prostate cancer are initially sensitive to luteinizing hormone-releasing hormone (LHRH) agonists/antagonists or orchiectomy, but can eventually progress to tolerance to these endocrine therapies, called castrate-resistant prostate cancer (CRPC). resistant prostate cancer (CRPC).
Destructive-resistant prostate cancer is more difficult to treat than androgen-sensitive prostate cancer.
Why does “destructive” prostate cancer develop?
Why does it develop?
Destructive prostate cancer can grow in spite of low levels of androgens for these reasons:
- Increased expression of androgen receptor molecules in desmoplastic-resistant prostate cancer cells;
- Mutations in intracellular androgen receptor-related genes and higher androgen receptor activity produced by cells;
- Changes in the activity of proteins regulating androgen receptor function.
The reasons for this are not easy to understand, but we just need to remember that after orchiectomy, the adrenal glands still produce androgens, and although androgen levels are low, destructive prostate cancer can still use these seemingly “insignificant” androgens to grow. strong>.
How to prevent the development of “resistant” prostate cancer?
How can we prevent the development of “depot-resistant” prostate cancer?
Doctors cannot predict when endocrine therapy will lose its inhibitory effect on prostate cancer growth. Therefore, patients receiving endocrine therapy need to have their blood levels of prostate-specific antigen (PSA) tested regularly.
An elevated PSA level means that the patient’s prostate cancer cells are growing again, while at the same time, if the patient’s androgen levels remain very low, the prostate cancer has become tolerant to the endocrine therapy currently being used.
How is “depression-resistant” prostate cancer treated?
What is the treatment for “destructive” prostate cancer?
Treatment for destructive-resistant prostate cancer includes the following:
Treatment for destructive-resistant prostate cancer includes the following
- Anti-androgen drugs, such as flutamide, bicalutamide, nilumide, and enzalutamide.
- Androgen synthesis inhibitors, such as ketoconazole, amiloride, and abiraterone acetate.
- Immunotherapy, such as the sipuleucel-T-cell vaccine. This vaccine works by using the patient’s own immune cells to fight metastatic prostate cancer cells that are not responding to hormone therapy.
- Chemotherapy drugs, most often docetaxel. If docetaxel treatment does not work, cabazitaxel may also be used.
- Radium chloride (radium 223), a radiopharmaceutical, has been approved abroad for the treatment of patients with desmoid-resistant prostate cancer who develop symptoms of bone metastases. The drug is able to gather at bone metastases and release rays to kill cancer cells.
Patients with desmoplastic-resistant prostate cancer who receive these treatments should also continue to receive first-line endocrine therapy (such as an LHRH agonist) to avoid tumor progression due to elevated testosterone levels.
Randomized controlled clinical trials have demonstrated that patients with metastatic desmoplastic-resistant prostate cancer can extend their survival after treatment with abiraterone acetate or enzalutamide, regardless of whether they have received chemotherapy.
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