Editing Castrate-Resistant Prostate Cancer (section)

== Background ==

* '''Treatment with androgen-deprivation therapy (ADT) almost always leads to resistance to ADT''' (i.e., cancer progression despite castrate levels of serum testosterone i.e. castrate-resistant prostate cancer)
* '''Follow-up in patients treated with ADT (3):'''
*# '''PSA'''
*# '''Imaging (bone scan and CT scan)'''
*# '''Serum testosterone'''
** PSA, bone scans, and CT scans provide information on disease progression.
*** '''PSA'''
****'''Rising PSA is usually the first manifestation of disease progression on ADT'''
***** In patients with metastatic disease, a rise in serum PSA level precedes evidence of advancing disease on the bone scan, and during this time patients may remain relatively asymptomatic.
*** '''Serum testosterone'''
****'''May provide important information where (2):'''
*****'''There might be reasons to suspect treatment non-compliance OR'''
*****'''The choice of previous treatment involved regimens known not to result in a sustained suppression of serum testosterone to castrate levels (e.g., monotherapy with non-steroidal androgen-receptor antagonist)'''
*'''<span style="color:#ff0000">Consider neuroendocrine differentiation in patients without significant PSA elevations who (2):'''
*#'''<span style="color:#ff0000">Do not respond to first-line ADT OR'''
*#'''<span style="color:#ff0000">Progress clinically or radiologically'''
*#* '''Biopsy of accessible lesions should be considered to identify these patients; these patients should then be treated with combination chemotherapy, such as cisplatin/etoposide or carboplatin/etoposide'''