Metastatic castration-resistant prostate cancer (mCRPC)

Descripción general

Metastatic castration-resistant prostate cancer (mCRPC) is prostate cancer that has spread away from the prostate and no longer responds to hormone therapy treatments. Hormone therapy for prostate cancer, also called androgen deprivation therapy (ADT), lowers the levels of the hormone testosterone in the body. Prostate cancer cells typically use testosterone to help them grow.

In healthcare, castration means lowering testosterone to a very low level. This is almost always done with medicines, but surgery also can lower testosterone. Hormone therapy medicines often control the cancer for years. Over time, many cancers adapt and begin growing again, even when testosterone levels stay low. When this happens, it's called castration-resistant prostate cancer (CRPC).

CRPC can be nonmetastatic or metastatic. Nonmetastatic CRPC (nmCRPC) means that imaging tests don't detect any cancer outside of the area of the prostate. When imaging tests find areas of cancer in other parts of the body, it's considered to be mCRPC.

When cancer spreads, healthcare professionals say it metastasizes. Metastatic prostate cancer happens when the cancer spreads from the prostate to other parts of the body. Sometimes the cancer spreads and hormone therapy helps control it. This is called metastatic castration-sensitive prostate cancer (mCSPC). If the cancer spreads and no longer responds to hormone therapy medicines, it's considered mCRPC.

There are many treatments for metastatic castration-resistant prostate cancer. While they may help manage the disease and extend your life, treatments aren't likely to cure the cancer. Treatments may include hormone therapy, chemotherapy, targeted therapy, radiopharmaceutical therapy and others. You also might consider taking part in a clinical trial.

Other terms for metastatic castration-resistant prostate cancer include metastatic castrate-resistant prostate cancer, metastatic hormone-resistant prostate cancer and metastatic ADT-resistant prostate cancer.

Síntomas

Metastatic castration-resistant prostate cancer doesn't always cause symptoms at first. This cancer happens when prostate cancer spreads and no longer responds to hormone therapy treatments. Sometimes it's found with blood tests or imaging tests before it causes symptoms.

Having a prostate cancer that is castration resistant doesn't cause specific symptoms. Symptoms typically happen when the cancer grows large enough to cause symptoms.

Symptoms may include:

• Difficulty getting started when urinating.
• Straining to urinate.
• Weak urine stream.
• Back pain.
• Bone pain.
• Weakness in the arms and legs.
• Bones that break without a clear cause, such as an accident or fall.
• Feeling very tired.

When to see a doctor

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

Causas

Metastatic castration-resistant prostate cancer happens when the cancer grows and spreads despite treatment with hormone therapy. Hormone therapy uses medicines or surgery to lower the level of testosterone in the body. Prostate cancer cells often use testosterone to help them grow.

For most prostate cancers, hormone therapy helps control the disease at first. Eventually the cancer cells may figure out how to grow without testosterone. Cells that can grow during hormone therapy are called castration-resistant cells. It's difficult to predict how long until the cancer becomes resistant to hormone therapy. About half of those treated with hormone therapy become resistant within 2 to 3 years. And about half become resistant after more than 2 to 3 years.

Healthcare professionals think this might happen because:

• Some cells don't need testosterone to grow. If most of the cancer cells need testosterone to grow, hormone therapy may control the cancer at first. But if some of the cells don't need testosterone, they might keep growing and multiplying. With time, those few cells could turn into many.
• Some cells change in response to treatment. Cancer cells might adapt to treatment and change. The changes could allow the cells to grow and multiply, even as treatment continues. Sometimes prostate cancer treated with hormone therapy turns into treatment-related neuroendocrine prostate cancer. This type of prostate cancer resists hormone therapy treatment.

Metastatic prostate cancer happens when cells break away from the cancer in the prostate and spread to other parts of the body. If the cancer no longer responds to hormone therapy, then it's considered metastatic castration-resistant prostate cancer.

Prostate cancer cells can spread through the blood or through the lymphatic system. When prostate cancer spreads, it most often goes to:

• Lymph nodes.
• Bones.
• Liver.
• Lungs.

Factores de riesgo

There are no risk factors for metastatic castration-resistant prostate cancer.