Guidelines for the management of castrate-resistant prostate cancer

Advanced prostate cancer has been known under a number of names over the years, including hormone resistant prostate cancer (HRPC) and androgen insensitive prostate cancer (AIPC). Most recently, the terms castrate resistant prostate cancer or castration recurrent prostate cancer (CRPC) were introduced with the realization that intracrine/paracrine androgen production plays a significant in the resistant of prostate cancer cells to testosterone suppression therapy(1). In their second publication, the Prostate Cancer Working Group (PCWG2) defined CRPC as a continuum on the basis of whether metastases are detectable (clinically or by imaging) and whether the serum testosterone is in the castrate range by a surgical orchidectomy or medical therapy (2). This creates a clinical-states model where patients can be classified. The rising PSA states (castrate and noncastrate) signify that no detectable (measurable or non-measurable) disease has ever been found. The clinical metastases states (castrate and noncastrate) signify that disease was detectable at some point in the past, regardless of whether it is detectable now.