Friday 11 December 2020

Castration resistant prostate cancer (CRPC)

It is defined as medical or surgical castration, with castrate serum testosterone < 50 ng/dl, or < 1.7 nmol/l, plus one of the following types of progression [1]:
  • Biochemical progression:
    • Three consecutive rises in total prostate-specific antigen (PSA), at least 1 week apart, resulting in two 50% increases over the nadir, and at least one total PSA > 2 ng/ml [1];
    • Or a rising total PSA that is greater than 2 ng/mL higher than the nadir, the rise has to be at least 25% over nadir and the rise has to be confirmed by a second total PSA at least three weeks later [2];
    • For CRPC diagnosis, PSA progresses despite secondary hormonal manipulations, including anti‐androgen withdrawal for at least 4 weeks [3].
  • Radiologic progression: The appearance of new lesions, either two or more new bone lesions on bone scan or a soft tissue lesion using the Response Evaluation Criteria in Solid Tumours (RECIST).
Bibliographic reference:
[1] Cornford P, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part II: Treatment of Relapsing, Metastatic, and Castration-Resistant Prostate Cancer. Eur Urol. 2017 Apr;71(4):630-642. Available at: https://doi.org/10.1016/j.eururo.2016.08.002.
[2] Scher HI, Halabi S, Tannock I, et al.; Prostate Cancer Clinical Trials Working Group. Design and end points of clinical trials for patients with progressive prostate cancer and castrate levels of testosterone: recommendations of the Prostate Cancer Clinical Trials Working Group. J Clin Oncol. 2008 Mar 1;26(7):1148-59. Available at: https://doi.org/10.1200/jco.2007.12.4487.
[3] Heidenreich A, Aus G, Bolla M, et al.; European Association of Urology. EAU guidelines on prostate cancer. Eur Urol. 2008 Jan;53(1):68-80. Available at: https://doi.org/10.1016/j.eururo.2007.09.002.

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