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I have stated many times in this forum before that treating castration-resistant prostate cancer (CRPC) is analogous to trying to hit a moving target. The better we get at treating it, the more the disease is able to evolve and adapt and acquire new mechanisms of drug resistance and lethality.
I love the year-end lists and the person of the year articles that always come out at this time. whether it is TIME magazine or Sports Illustrated or even People magazine (…not that I follow the worlds sexiest man and woman contest that closely), they help us give a perspective of the shifts in our world that occur within a year.
I just returned from a tremendously insightful meeting at the National Cancer Institute on the lineage plasticity of prostate cancer. The focus of the meeting was the myriad changes that systemic treatment induces in prostate cancer over time – most notably the emergence of neuroendocrine/small cell prostate cancer. I’ll address this entity in a subsequent entry. Before that, though, the striking focal point of discussion at the meeting was a single molecule -RB  ( or, the retinoblastoma gene)
Earlier this year I wrote a piece on the need to learn from the ERA-223 experience and pitched it in the context of the Apollo 13 moon mission, dubbed a “successful failure’ because it revealed a variety of problems in the space mission and created the opportunity to revise process based on continued close scrutiny of the data*. At ESMO 2018, the closer scrutiny of ERA-223 has indeed delivered some new information about our best practices in mCRPC.
Here’s some interesting science to follow and think about in the context of mCRPC treatment. – how cancer and cancer treatment will influence and even accelerate aging – and what we can do about it.

My institution, the University of Minnesota, recently launched a “Medical Discovery Team on the Biology of Aging” a program that brings together clinicians,
If things were different, I might be writing this blog about using Selinexor in prostate cancer.

Or,  I might be working on the design of the phase III study of BEZ235 in mCRPC, or the use of AMG-102 plus mitoxantrone in patients following docetaxel for mCRPC.
A new diagnosis of metastatic prostate cancer is life-altering.  Deciding on the treatment used to be straightforward but it’s not anymore. After addressing this issue with patients for many years, and staying abreast of the latest developments, I describe an approach to starting treatment in five questions for both the patient

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