Prostate cancer can be broken down into different types depending on the nature of your disease:
- Castration-Resistant Prostate Cancer (CRPC)
- Non-Metastatic Castration-Resistant Prostate Cancer (nmCRPC)
- Metastatic Castration-Resistant Prostate Cancer (mCRPC)
- Metastatic Prostate Cancer
- Metastatic Hormone-Sensitive Prostate Cancer (mHSPC)
Although the titles are a mouthful, they’re not as complicated as they seem at first glance.
Castration-Resistant Prostate Cancer (CRPC)
Hormone therapy and starving the cancer
Cancer needs fuel to survive. With prostate cancer, testosterone does the job in most cases.
That’s why hormone therapy is a common approach to fighting this cancer: by reducing the level of testosterone in the body, we can potentially starve the cancer and stop it from growing. Another name for this is androgen deprivation therapy.
There are different ways to go about hormone therapy, including medications (hormone-blocking drugs) or surgery to remove the testicles (castration). The testicles produce androgens like testosterone, so removing them will dramatically reduce the testosterone levels of your body (around a 90%–95% drop).
Whichever route is taken, the goal of hormone therapy is to reduce your testosterone level all the way down to that of a castrated person. In approximately 90% of advanced prostate cancer cases, the tumor shrinks with hormone therapy.
Hormone therapy can significantly slow down the cancer and alleviate side effects, potentially adding years to your life — but it’s not an outright cure. The issue is that not all cancer cells are fueled by hormones, so with time, these cancer cells may grow and spread. On top of that, cancer cells reliant on androgens can also adapt to the lower levels and start multiplying again.
Once hormone therapy has hit a ceiling with its ability to contain cancer, we redefine the cancer as castration-resistant prostate cancer. In other words, this is a cancer that can survive and grow, even with dramatically reduced testosterone levels, so your doctor will have to revise your treatment strategy.
What is castration-resistant prostate cancer (CRPC)?
CRPC is how we describe the point where cancer keeps growing, even when testosterone levels are on par with or below castration levels (less than 50 ng/dL). CRPC is also known as hormone-refractory or hormone-resistant prostate cancer.
We can diagnose CRPC through testing to see if your prostate-specific antigen (PSA, a protein produced by prostate cells) level continues to rise while your testosterone level remains low. This can be backed up by imaging tests that offer visual clues of a growing cancer. PSA doubling time refers to the time it takes for your PSA levels to double.
Central to your treatment strategy will be to stop the cancer frommetastasizing, which means spreading. When cancer spreads, it can be much harder to treat and contain.
If your CPRC has spread beyond the prostate, we can more specifically call it metastatic castration-resistant prostate cancer (mCRPC); if it hasn’t, we call it non-metastatic castration-resistant prostate cancer (nmCRPC).
Your doctor has numerous testing options available to them to figure out if yours has spread.
Non-Metastatic Castration-Resistant Prostate Cancer (nmCRPC)
For patients with nmCRPC, the cancer remains contained within the prostate, and there are often no symptoms as well. To check if the cancer is growing, these patients usually must undergo regular testing with methods including blood tests and physical examinations.
Even though non-metastatic CRPC is not quite as serious as metastatic CRPC (meaning the cancer has spread), it is worthwhile for patients to learn the symptoms of the latter type in case your cancer begins to spread.
Symptoms can be a sign that the cancer has spread outside of the prostate, and the type of symptoms you experience depend on the tumor size and affected organs. Make sure to watch out for:
- Issues with urinating
- Blood in the urine
- Tiredness
- Weakness
- Breathlessness
- Weight loss
- Bone pain
Sometimes, it’s not obvious that symptoms are related to the cancer, and some men are also reluctant to talk about these issues with their doctor. However, it is vital that you keep them informed of any developments, even if it seems trivial or irrelevant.
Metastatic Castration-Resistant Prostate Cancer (mCRPC)
This is the type of CRPC that has spread beyond the prostate and for which hormone therapy no longer works. It is normal for hormone therapy to stop working after a few years, and many men with prostate cancer go on to develop mCRPC.
mCRPC can spread to many different parts of the body, for example the nearby lymph nodes, bones, bladder, rectum, liver, lungs, and even the brain. There may be no symptoms, but if there are, these include:
- Issues with urinating
- Blood in the urine
- Tiredness
- Weakness
- Breathlessness
- Weight loss
- Bone pain
Unfortunately, this subtype can be hard to treat — even if doctors catch it early on. This is because it tends to be quite aggressive.
There are numerous treatment options available for mCRPC patients. The main idea here is to slow progress and control symptoms. Your doctor may ask you to stay on hormone therapy because, even though it’s no longer able to contain the cancer, stopping it could actually make things worse.
Typical treatment strategies for mCRPC include:
- Chemotherapy
- Hormone therapy
- Immunotherapy
- Radiation therapy
- Treatments to ease symptoms
Metastatic Prostate Cancer
When prostate cancer spreads, we call it metastatic prostate cancer. You may also hear your doctor saying that the cancer has metastasized.
There are common ways in which this plays out. Prostate cancer mostly spreads to the lymph nodes or bones, but the liver and lungs are also relatively common. Rarely, it can reach more distant parts of the body like the brain, kidneys, pancreas, and spleen.
Even when this cancer has spread to other parts of the body, we still refer to it as prostate cancer. Metastatic prostate cancer does not have a cure, but it is possible to treat and manage the disease. In fact, a majority of patients live a relatively normal life, and their lifespan can be comparable to that of a healthy person.
There is an important distinction with metastatic prostate cancer that sets it apart. It specifically refers to cancer that has left the prostate and traveled to more distant parts of the body. Locally advanced prostate cancer is how we describe cancer that has only spread to tissues nearby to the prostate, and this type can be cured.
As one of the first destinations for prostate cancer that spreads, the lymph nodes can act as a launching pad for the cancer to colonize other parts of the body too. The same goes for the bloodstream, as this allows the cancer to deposit its cells in numerous sites around the body. Bone metastasis, i.e., cancer that has spread to the bones, make up approximately 85%–90% of all metastatic prostate cancer cases.
Localized protate cancer is often low risk and carries an excellent prognosis. Patients with more aggressive cancer variations are more likely to experience progression to metastatic disease. The key is to catch it early, as this gives us the best chance at preventing it from spreading.
In some cases, patients are completely unaware they have prostate cancer until it spreads. Doctors can determine this through testing, for example, with bone scans, PET scans, CT scans, or an MRI.
Metastatic Hormone-Sensitive Prostate Cancer (mHSPC)
This advanced prostate cancer subtype is when cancer has spread outside the source, but it can still be treated with hormone therapy. That means that blocking androgens like testosterone will continue to be effective at slowing or stopping the growth of the cancer. Discontinuing hormone therapy has the potential to fuel mHSPC, making it grow more powerful.
There is currently no cure for mHSPC, but it is possible to slow it down and manage it. Besides going on some kind of hormone blocking medication program, some mHSPC patients may be asked to consider having surgery to remove their testicles, which could help to starve the cancer.
A note on treating castrate-resistant prostate cancer
Even if your CRPC has metastasized, a combination of medications and other treatments can significantly hamper the progression of the disease.
You might think that hormone therapy is pointless now because you have been diagnosed with CRPC, but that’s not necessarily the case. Your doctor may recommend keeping you on hormone therapy because allowing a natural rise in testosterone could add more fuel to the fire, making the cancer even worse.
Treating CRPC heavily depends on whether yours has metastasized.
Some of the main treatment options available include:
- Chemotherapy. Thesemedications directly kill cancer cells, but the side effects can be difficult to tolerate.
- Immune therapy. A complicated procedure that involves making a personalized vaccine using your own white blood cells. The vaccine assists your immune system with attacking the cancer cells and can help to extend your lifespan.
- 2nd generation androgen therapies. There are specialized hormone therapies available that can be effective with CRPC cases, and trials have shown that they can help you live longer.
- Radiation therapy. Using high-energy rays or particles, we can attack cancer cells as a main treatment or to relieve symptoms; for example, if you have urinary issues (peeing) caused by a tumor.
- Treatments for bone-metastases. If your cancer has spread to your bones, there are specific treatments to tackle this problem including drugs, corticosteroids, and radiation therapy. The bones are the most common place for advanced prostate cancer to spread, and tumors here can cause bone fractures and intense pain.
Source: StoryMD
Accord: WS-ABI-2300001