Treatment of hormone-resistant prostate cancer

After being diagnosed with prostate cancer, male patients must go to a regular hospital for treatment in a timely manner. Don't delay going because of face problems, delaying the treatment and regretting it later. Therefore, prostate cancer patients must receive timely treatment and relieve the pain as soon as possible through the treatment method that suits them. Let's take a look at the treatment of hormone-resistant prostate cancer.

Definition of hormone resistance

The following conditions must be met simultaneously:

1. Plasma testosterone reaches castration level (usually defined as castration level <50ng/ml);

2. Plasma PSA measured three times at intervals of 2 weeks increases successively;

3. Stop taking anti-androgenic drugs for at least 4 weeks (Casodex needs to be stopped for at least 6 weeks);

4. PSA continues to rise despite second-line endocrine therapy; or bone or soft tissue lesions continue to progress.

The mechanism of androgen resistance or hormone independence has not been clearly elucidated, and the main possible hypotheses are:

1. Selective growth of hormone-resistant prostate cancer cell clones;

2. Androgen receptor mutation;

3. Prostate cancer cells adapt to the emasculation environment;

4. Changes in signal transduction pathways in prostate cancer cells;

5. Upregulation of anti-apoptotic genes, etc. (1).

The treatment of hormone-resistant prostate cancer (HRPC) is a multidisciplinary, multi-strategy comprehensive treatment.

1. Maintaining androgen deprivation therapy

If the patient's blood testosterone does not reach <50 ng/ml, LHRH-a (luteinizing hormone-releasing hormone analog) should be continued to ensure that blood testosterone is maintained at castrate levels (4, 5).

2. Chemotherapy

For a long time, prostate cancer has been considered a malignant tumor that is insensitive to chemotherapy. Between 1988 and 1992, 26 single chemotherapy drugs were used to treat prostate cancer, with an overall response rate of only 8.7% and a median survival time of 10-12 months. The efficacy was disappointing; and chemotherapy brought many toxic side effects, which once made chemotherapy neglected. The emergence of docetaxel has opened up a new prospect for chemotherapy of prostate cancer. The two phase III clinical trials TAX327 and SWOG9916 reported at ASCO in 2004 have established the first choice of chemotherapy with docetaxel as the core in the treatment of HRPC.