Non-metastatic castration-resistant prostate cancer: current status and future directions.

The emergence of novel hormonal therapies and the increase availability of sensitive next-generation imaging techniques has significantly changed the management of recurrent prostate cancer.

In this review, we summarize the definition, diagnosis, treatment, and ongoing clinical trials in non-metastatic castration resistant prostate cancer (M0CRPC). We have also discussed the role of newer imaging modalities in the detection of advanced prostate cancer.

M0CRPC is a disease state in prostate cancer when serologic progression (PSA only disease) occurs despite castrated levels of testosterone and imaging shows no evidence of metastasis. With the availability of next-generation imaging, more patients are migrating from M0CRPC to mCRPC space. This stage migration impacts the treatment options currently available in clinical practice and requires the integration of novel imaging in prospective studies moving forward. Until that data become available men with M0CRPC should be considered for therapy with any of these three novel oral AR inhibitors, with a positive impact in metastasis-free and overall survival. Treatment selection should be based on Quality of Life, side effects, and drug-drug interactions.

Expert review of anticancer therapy. 2020 Jun 07 [Epub ahead of print]

Ruby Gupta, Iris Y Sheng, Pedro C Barata, Jorge A Garcia

Department of Hematology and Medical Oncology, William Beaumont Hospital , Royal Oak, MI, USA., Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute , Cleveland, OH, USA., Deming Department of Medicine, Section of Hematology Oncology, Tulane University Medical School , New Orleans, LA, USA., GU Oncology Research Program, University Hospitals Seidman Cancer Center, Case Western Reserve University , Cleveland, OH, USA.