Last month we saw the final published data from the PROSPER study1, and coupled with the earlier published SPARTAN study2, we now have two complete and large phase III studies detailing the clinical activity of androgen-receptor inhibitors, enzalutamide and apalutamide in so-called “non-metastatic” castrate-resistant prostate cancer (nmCRPC) patients. I am impressed with the results of these two studies; both demonstrated a robust clinical effect in delaying or preventing the development of metastases in this patient population that I believe is clinically beneficial in patients who are likely to live long enough to die from metastatic prostate cancer.  While I appreciate the FDA approval of these agents to treat this patient population, I don’t like this term non-metastatic CRPC.
For those of us who are responsible for treating men with metastatic castration-resistant prostate cancer (mCRPC), we’ve all seen the ravages that this disease bestows on its victims – bone pain, weakness, anorexia/weight loss, anemia and other cytopenias and fatigue, profound fatigue.

Normally, we can see this coming – both in terms of the symptoms progressing through the last year or year and a half of life, as well as the tumor burden. Until recently, it has been hard to quantify these factors.
How many times has a patient with advanced prostate cancer said to you, “I have bone cancer?” 

In the past, I would smile politely and correct them by saying, “actually what you have is prostate cancer that has spread to your bones.” But, what if they are right? I mean, many of these patients have previously undergone a prostatectomy or radiation therapy, and have no evidence of local disease. Sure, the patient may have an elevated prostate-specific antigen (PSA) level, but does that alone really make this prostate cancer? 
Our ability to offer a multitude of effective therapies for the advanced prostate cancer patient continues forward, enhancing patient outcomes while minimizing quality of life untoward effects. Radium 223 (Xofigo), approved in May 2013, is the most recently approved and efficacious advanced prostate cancer (PCa) treatment, receiving level one guidelines endorsements from AUA, EAU, ASCO, ESMO, and NCCN. This addition of CRPC Bone Metastases: Center of Excellence, highlights 3 important publications, each with novel information which supports the clinician responsible for advanced PCa patients with bone metastases burden, the predominant site of metastatic location with well documented meta-analyses for advanced PCa patients worldwide. 
Welcome to the Center of Excellence on Castration Resistant Prostate Cancer (CRPC) with Bone Metastases. I am Dr. Neal Shore, MD, FACS, CPI, Director of the Carolina Urologic Research Center (CURC), Atlantic Urology Clinics, Myrtle Beach, South Carolina. Founded in 1998, CURC is currently supported by 13 Urologists, 3 Radiation Oncologists, 1 Pathologist, 10 Advanced Practice Providers, and a team of 10 fulltime research and administrative CURC personnel.

Coming soon