Written by Muresanu H., Ioiart I.   
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Authors:MUREȘANU Horia, IOIART Ioan
Affiliation:Department of Urology, Faculty of Medicine, Vest University Vasile Goldiș, Arad, Romania
Abstract:Based on the increased understanding of the biochemical pathways that promote tumor survival a range of new treatments become available. Drug development based on biology-guided rationale coupled with intelligent trial design will find promising new treatment options for castrate resistant prostate cancer (CRPC). The androgen receptor plays the key role in prostate cancer even during castrate resistance, and therapies targeting it represent the future for treating CRPC. During progression to CRPC induced by persistent androgen deprivation, androgen receptor (AR) signaling is maintained through a variety of mechanism including increased expression of AR, amplification of the AR gene, and structural changes in AR caused by genetic mutations or mRNA splice variants. Clinical consideration has been added to the conventional staging criteria to describe the extent of the disease beyond the simple anatomic classification. For patients with metastatic CRPC who have previously received docetaxel chemotherapy Abiraterone acetate is a novel androgen biosynthesis inhibitor that has gained FDA approval. For men with asymptomatic or minimally symptomatic metastatic CRPC Sipuleucel-T is the first therapeutic vaccine to be FDA approved. Immunotherapy also has several potential benefits for patients with CRPC, including lack of toxicity and maintains of quality of life. It is an exciting time in the management of CRCP with new agents under development. Such evolution in treatment approach will necessitate an evolution of the urologist from being primary a surgeon to becoming more an applied molecular biologist.
Keywords:Castrate resistant prostate cancer, androgen receptor, androgen receptor -independent and androgen receptor -dependent mechanism
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*Correspondence:Muresanu Horia
Spitalul Clinic Judetean de Urgenta Arad
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