The future is here
Personalized treatment for castrate resistant metastatic prostate cancer:
Prostate cancer is the most common cancer in men. The principal risk factor for the development of prostate cancer is old age. Approximately 70-80% of the diagnoses regard men aged 65 years and over. In the last five years many new treatments have been developed and approved for the hormone resistant metastatic prostate cancer, while, at the same time, our knowledge about the molecular biology of the disease has significantly increased, while there is also a more correct use of older treatments.
Prostate cancer is promoted by the androgens (testosterone and dihydrotestosterone), which consist a growth factor both of normal and of cancer prostate cells. 90-95% of testosterone is produced in the testes and 5-10% in the adrenals. The growth-promoting effect of androgens is achieved through their binding to androgen receptors and the activation of target genes in cancer cells. The surgical castration or/and the chemical castration (the respective LHRH, antiandrogens and their combinations) that reduce the testosterone that circulates in the human body by 90-95% preventing thus the growth of the tumor, is the first and basic therapeutic handling.
However, we know that in the majority of patients, the disease will eventually become, at different time points in the various cases, resistant to castration and, at this point, the older and new therapeutic approaches are applied. From the established docetaxel which, offering survival benefits, has been already approved since 2004 for the disease, we have began using newer, innovative hormonal procedures. The drugs abiraterone acetate (Zytiga) and enzalutamide (XTANDI), have received the approval to be administered both before docetaxel, and after its failure, because they have demonstrated in large clinical studies significantly longer survival times.
While us the oncologists, have finally today, the possibility to use a newer chemotherapeutic agent, cabazitaxel (Jevtana), which has been approved for use after the failure of docetaxel, offering in its turn benefits regarding the overall survival. Despite the undisputed progress that has taken place, the metastatic castrate resistant prostate cancer remains a principal, basic and important therapeutic challenge. Through the continuous study of the biology of cancer and with the aid of basic research we try every day to discover the evolution and resistance mechanisms the prostate cancer cells develop to the administered treatments, so that we can personalize the therapeutic approach of our patients, offering them the maximum possible benefit.