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Korean J Urol Oncol > Volume 11(1); 2013 > Article
The Korean Journal of Urological Oncology 2013;11(1): 11-16.
비전이 거세저항성 전립선암
권택민, 정인갑
울산대학교 의과대학 비뇨기과학교실, 서울아산병원 비뇨기과
Non-Metastatic Castration-Resistant Prostate Cancer
Taekmin Kwon , In Gab Jeong
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Published online: April 30, 2013.
Most men with advanced prostate cancer respond to various types of androgen ablation but eventually progress to castration-resistant prostate cancer (CRPC). However, many patients will have an increase in prostate specific antigen (PSA) on hormonal therapy without radiographic evidence of disease. For this reason, heterogeneous population of non-metastatic CRPC (non-mCRPC) has appeared. To date, PSA kinetics is the most powerful indicator of aggressiveness in that population and can be used to trigger imaging investigation and enrollment in clinical trials. Although CRPC remains largely driven by the androgen receptor, the benefit of second-line hormonal manipulations, including first generation antiandrogens, adrenal synthesis inhibitors and steroids, is clearly limited. Several registered and near to come treatments have not been tested in that population but in men with more advanced metastatic and often symptomatic disease. Several agents have been investigated to delay the onset of the first bone metastasis but only one, denosumab, has reached its end-point. But, overall survival did not differ. Physicians should recognize that non-mCRPC is an extremely heterogeneous stage of the disease, with most patients progressing slowly to a metastatic stage and acknowledge that the available registered treatments have been studied in far more advanced stage of the disease. (Korean J Urol Oncol 2013;11:11-16)
Key Words: Prostatic neoplasm; Castration; Androgens; Neoplasm metastasis
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