Complexities of Prostate Cancer

Abstract

Prostate cancer has a long disease history and a wide variety and uncertainty in individual patients' clinical progress. In recent years, we have seen a revolutionary advance in both prostate cancer patient care and in the research field. The power of deep sequencing has provided cistromic and transcriptomic knowledge of prostate cancer that has not discovered before. Our understanding of prostate cancer biology, from bedside and molecular imaging techniques, has also been greatly advanced. It is important that our current theragnostic schemes, including our diagnostic modalities, therapeutic responses, and the drugs available to target non-AR signaling should be improved. This review article discusses the current progress in the understanding of prostate cancer biology and the recent advances in diagnostic and therapeutic strategies.

Keywords: AR signaling; PSA; mutation; prostate cancer; resistance.

Figure 1

Management overview of prostate cancer. Patients with localized prostate cancer are predominantly managed with either active surveillance or local treatment. The division into low-, intermediate-, and high-risk prostate cancer uses multiple parameters, such as the number of cancer-positive biopsy cores, the length of tumor architecture in the cores, molecular signatures, and imaging results, and inform the decision between active surveillance, single modality therapy, or multimodality therapy. Prostate-specific antigen (PSA) level since diagnosis, indirectly representing the tumor burden, increases in patients whose prostate cancer fails to respond to local and systemic therapies in the progression to metastatic disease. The aggressive prostate cancers are associated with the progression from localized to metastatic castration-sensitive prostate cancer (mCSPC) and metastatic castration-resistant prostate cancer (mCRPC). The treatment approach is switched from curative to palliative care in the disease progression. ADT: androgen deprivation therapy, PARPi: poly(adenosine diphosphate–ribose) polymerase inhibitor, PLND: pelvic lymph node dissection, RP: radical prostatectomy, RT: radiotherapy.