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Nonmetastatic castration resistant Prostate cancer

Defined as prostate cancer with rising PSA level in the setting of castrate serum testosterone level of less than 50ng/dL in the absence of visible disease spread, following initial definitive therapy.

About 1/3 of patients with nmCRPC develop metastatic disease within one year.

Only two factors are known  to predict for the time to onset of metastasis and the nonmetastatic castration resistant prostate cancer: PSA doubling time of less than three months has a median time to metastasis of approximately nine months; If PSA doubling time is longer than 15 months the time to metastasis is longer than four years.

Shorter  PSA doubling time is associated with reduced bone metastasis free  survival time among patients with nmPRPC.

Preventing or delaying progression to metastatic CRPC prolongs  patient survival and improved quality of life.

Treatments for nmPRPC include apalutamide enzalutamide, and darolutamide.

These androgen receptor inhibitors act by competitively inhibiting antigen binding, antigen receptor nuclear translocation, and androgen receptor mediated transcription.

These androgen receptor inhibitors approved for nonmetastatic call prostate cancer improve metastasis free survival an overall survival and appear to have similar efficacy.

These androgen receptor inhibitors prolong metastatic free survival by approximately two years.

Approximately 80% will develop metastatic disease within three years.

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