Table of ContentsView AllTable of ContentsTypes of Castration-Resistant Prostate CancerSymptomsCausesDiagnosisTreatmentPrognosisCoping
Table of ContentsView All
View All
Table of Contents
Types of Castration-Resistant Prostate Cancer
Symptoms
Causes
Diagnosis
Treatment
Prognosis
Coping
Metastatic castration-resistant prostate cancer (mCRPC) and its precursor, metastatic hormone sensitive prostate cancer (mHSPC), are advanced forms of the condition that don’t respond to initial treatments, such as surgery and hormone therapy, and have started to spread beyond the prostate.
The type mCRPC differs from mHSPC in that the latter disease still responds to standard hormone treatment called androgen deprivation therapy (ADT),even though it has spread to other parts of the body. Specifically, the castration-resistant form mCRPC is particularly dangerous and leads to a very poor prognosis.
The prostate is part of the male reproductive system that surrounds the urethra. The prostate gland produces some of the fluid that carries and protects sperm after ejaculation. Overall, prostate cancer is the second most common cancer in men (skin cancer is the first), with 268,490 new cases and about 34,500 deaths estimated for 2022.
Ariel Skelley/Getty Images
Castration-resistant prostate cancers are a class of cancer that do not respond to first-line treatments, which include surgery and/or a standard hormone treatment called androgen-deprivation therapy (ADT). While treatments for mCRPC can be highly effective, especially if the disease is caught early, it is generally incurable. Given that they’re resistant to some therapies, mHSPC and mCRPC represent particularly challenging cases for patients and medical professionals alike.
Whereas mCRPC and mHSPC refer to cases where the cancer cells have started to spread (also known as “metastasis”), nmCSPC is an earlier form that’s confined to the prostate.The difference between the former two of the three conditions is also a matter of progression, with mCRPC being the more advanced and widespread form of the cancer.
Here’s a quick breakdown of these related conditions:
Metastatic Hormone Sensitive Prostate Cancer (mHSPC)
This form of prostate cancer can be an initial diagnosis but more often refers to cases where surgeries or other initial treatments to remove tumors from the prostate haven’t succeeded in stopping its progression.
Metastatic Castration-Resistant Prostate Cancer (mCRPC)
Basically, mCRPC can be defined as mHSPC that has spread and progressed further, though the exact mechanism of how one leads to the other is not fully understood.
Symptoms of mCRPC/mHSPC
What’s challenging about some prostate cases is that there’s a chance they can be asymptomatic, especially in their earlier phases. When it comes to mCRPC and mHSPC, symptoms will arise not only in and around the prostate but in those other body systems to which the cancer has spread. These include:
If the cancer has started to spread, it can affect other bodily systems, leading to:
If you’ve been diagnosed with prostate cancer, or are experiencing any of these symptoms, seek out medical attention immediately.
Generally speaking, mCRPC and mHSPC arise as cancer cells start to develop and divide in the prostate and continue to spread despite therapy. Doctors still don’t fully understand the exact mechanism that causes this disease to arise; however, they have been able to localize a range of risk factors and associated conditions. Here’s a quick breakdown:
Generally speaking, prostate cancers are graded on a scale that goes from a score of 1, meaning least likely to metastasize to a score of 5, the most severe from. The aim of diagnosis, then, is to assess not only the presence of cancer, but to assess whether it is spreading, and if so, where it’s spreading to. This is typically done using several methods, including physical examination, blood tests, imaging, and core needle biopsy.
Physical Examination
The first step of diagnosis involves a careful review of medical history as well as a physical examination. This entails an assessment of any reported symptoms alongside an evaluation of relevant risk factors.
In addition, the doctor will perform adigital rectal examination (DRE), where they insert a gloved, lubricated finger into the rectum to physically feel for the presence of any tumors. If a potential problem is detected, they will order blood testing.
Prostate-Specific Antigen (PSA)
The primary blood work done if prostate cancer is suspected is the PSA blood test. This tests for the presence of a specific protein called the prostate-specific antigen. While all men have some PSA, higher levels may indicate the presence of cancer.
The PSA blood test is not definitive, but it can help doctors rule out cases where cancer is unlikely. Elevated levels will indicate the need for further tests.
Core Needle Biopsy
To confirm the diagnosis, a specialized doctor—usually a urologist—will need to perform a core needle biopsy of the prostate.This involves taking samples of prostate tissue and evaluating them for the presence of cancer cells.
If there are lesions in the bones or lymph nodes, a specialized doctor—interventional radiologist— may perform a targeted needle biopsy of the lesions.
Imaging
During biopsy and afterward, doctors will rely on imaging approaches, such as transrectal ultrasound, magnetic resonance imaging (MRI), computerized tomography (CT/CAT scan), X-ray, or positron emission tomography (PET scan) to assess the full extent of cancer spread and tumor growth.
The specific approach used is based on the location of the issues; for instance, transrectal ultrasound will focus on the prostate area, while CAT scan is typically best to assess if the cancer has spread to lymph nodes. Since prostate cancer easily spreads to bones, a specialized bone scan X-ray will be needed to fully assess the spread.
As with many cancer cases, more than one treatment approach may be necessary to yield therapeutic results.
Unfortunately, since mHSPC and mCRPC are more aggressive cancers, and since there’s no definitive cure, prognosis is relatively poor. That said, thanks to newly devised therapies and treatments, the numbers are improving.
Keep in mind that the numbers presented here are averages, and there can be a great deal of variation. Among the important measures when discussing cancer is survival rate at five years.
While the outlook for prostate cancers that have not spread is quite positive—if caught in time and treated, the majority of these patients are expected to be alive in five years. For those that have metastasized cancers, like mHSPC and mCRPC, the number is significantly lower—about 31%.
The most challenging question, of course, is the most important one: How long do patients have? There are many factors at play here, and probably the most crucial is timing. The sooner this cancer is discovered, the better the chances of a positive outcome.
Encouragingly, newer therapies have improved the outlook.As these have hit the market, researchers have already started seeing significant changes.
With a diagnosis of mHSPC, prognosis depends on how the disease responds to ADT treatment. The duration of response is highly variable—some men progress to a castrate-resistant state in less than one year, while others are still responding to ADT more than 10 years later.
In modern trials, men with mHSPC are often treated upfront with ADT in combination with additional drugs such as abiraterone or enzalutamide. Researchers are now seeing median survival times of at least four to five years, even in high-risk patients.
Also, the combination of drugs like Abiraterone with ADT as initial therapy in high-risk men which has improved prognosis in mHSPC up to at least four to five years in these cases.
There’s no doubt that a cancer diagnosis can be incredibly alarming and upsetting. At the end of the day, mHSPC and mCRPC represent advanced stages of a deadly disease, and there’s no doubt that treatment can be disruptive and difficult.
It’s absolutely essential to have a support system in place; though it can be very challenging, it’s helpful to talk to your family about what’s happening. Alongside close friends, they’ll be an essential source of help and support. The better you’re able to communicate, the easier everything will be.
Outside of friends and family, though, you may find the need to seek out professional counseling or a support group to help you cope. Psychiatrists and other mental health professionals can certainly help in this difficult time, so you may find it helpful to ask your oncologist about any services or experts they can recommend.
In addition, there are many support groups and services for those with cancer. In addition to providing clinical information, organizations such as theCancer Survivor’s Networkor theUrology Care Foundationhelp foster an enriching and supportive community of and for those suffering. The burden of this condition is intense; there’s no reason you should go it alone.
A Word from Verywell
There’s no way around the fact that a cancer diagnosis is a massive, life-altering event. On top of that, most treatment approaches can be very difficult and draining, both physically and emotionally.
As hard as it is, it’s important not to lose hope. While prognosis for mHSPC and mCRPC has been relatively poor, remember that it has been steadily improving as new therapies and approaches have been developed.
Today, people with metastatic prostate cancer, put simply, are in a much better position than they have ever been before. With the right care, and the support of loved ones, you can put yourself in a good position to combat this cancer.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Lapini A, Caffo O, Pappagallo G et al.Monitoring patients with metastatic hormone-sensitive and metastatic castration-resistant prostate cancer: a multidisciplinary consensus Document.Cancers (Basel). 2019;11(12):1908. doi:10.3390/cancers11121908Henriquez I, Spratt D, Gómez-Iturriaga A, Abuchaibe O, Couñago F.Nonmetastatic castration-resistant prostate cancer: Novel agents to treat a lethal disease. World J Clin Oncol. 2021 Jan 24;12(1):6-12. doi: 10.5306/wjco.v12.i1.6.American Cancer Society.Key statistics for prostate cancer.Teo M, Rathkopf D, Kantoff P.Treatment of advanced prostate cancer.Annu Rev Med. 2019;70(1):479-499. doi:10.1146/annurev-med-051517-011947Urology Care Foundation.What is advanced prostate cancer?American Cancer Society.Tests to diagnose and stage prostate cancer.American Cancer Society.Survival rates for prostate cancer.Damodaran S, Kyriakopoulos C, Jarrard D.Newly diagnosed metastatic prostate cancer: has the paradigm changed?Urol Clin North Am. 2017;44(4):611-621. doi:10.1016/j.ucl.2017.07.008Hoyle AP et al.Abiraterone in “high-” and “low-risk” metastatic hormone-sensitive prostate cancer.European Urology. 2019; 76:719-728. doi:10.1016/j.eururo.2019.08.006Fizazi K, Tran N, Fein L, et al.Abiraterone acetate plus prednisone in patients with newly diagnosed high-risk metastatic castration-sensitive prostate cancer (LATITUDE): final overall survival analysis of a randomised, double-blind, phase 3 trial.Lancet Oncol. 2019;20(5):686-700. doi:10.1016/S1470-2045(19)30082-8
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Lapini A, Caffo O, Pappagallo G et al.Monitoring patients with metastatic hormone-sensitive and metastatic castration-resistant prostate cancer: a multidisciplinary consensus Document.Cancers (Basel). 2019;11(12):1908. doi:10.3390/cancers11121908Henriquez I, Spratt D, Gómez-Iturriaga A, Abuchaibe O, Couñago F.Nonmetastatic castration-resistant prostate cancer: Novel agents to treat a lethal disease. World J Clin Oncol. 2021 Jan 24;12(1):6-12. doi: 10.5306/wjco.v12.i1.6.American Cancer Society.Key statistics for prostate cancer.Teo M, Rathkopf D, Kantoff P.Treatment of advanced prostate cancer.Annu Rev Med. 2019;70(1):479-499. doi:10.1146/annurev-med-051517-011947Urology Care Foundation.What is advanced prostate cancer?American Cancer Society.Tests to diagnose and stage prostate cancer.American Cancer Society.Survival rates for prostate cancer.Damodaran S, Kyriakopoulos C, Jarrard D.Newly diagnosed metastatic prostate cancer: has the paradigm changed?Urol Clin North Am. 2017;44(4):611-621. doi:10.1016/j.ucl.2017.07.008Hoyle AP et al.Abiraterone in “high-” and “low-risk” metastatic hormone-sensitive prostate cancer.European Urology. 2019; 76:719-728. doi:10.1016/j.eururo.2019.08.006Fizazi K, Tran N, Fein L, et al.Abiraterone acetate plus prednisone in patients with newly diagnosed high-risk metastatic castration-sensitive prostate cancer (LATITUDE): final overall survival analysis of a randomised, double-blind, phase 3 trial.Lancet Oncol. 2019;20(5):686-700. doi:10.1016/S1470-2045(19)30082-8
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Lapini A, Caffo O, Pappagallo G et al.Monitoring patients with metastatic hormone-sensitive and metastatic castration-resistant prostate cancer: a multidisciplinary consensus Document.Cancers (Basel). 2019;11(12):1908. doi:10.3390/cancers11121908Henriquez I, Spratt D, Gómez-Iturriaga A, Abuchaibe O, Couñago F.Nonmetastatic castration-resistant prostate cancer: Novel agents to treat a lethal disease. World J Clin Oncol. 2021 Jan 24;12(1):6-12. doi: 10.5306/wjco.v12.i1.6.American Cancer Society.Key statistics for prostate cancer.Teo M, Rathkopf D, Kantoff P.Treatment of advanced prostate cancer.Annu Rev Med. 2019;70(1):479-499. doi:10.1146/annurev-med-051517-011947Urology Care Foundation.What is advanced prostate cancer?American Cancer Society.Tests to diagnose and stage prostate cancer.American Cancer Society.Survival rates for prostate cancer.Damodaran S, Kyriakopoulos C, Jarrard D.Newly diagnosed metastatic prostate cancer: has the paradigm changed?Urol Clin North Am. 2017;44(4):611-621. doi:10.1016/j.ucl.2017.07.008Hoyle AP et al.Abiraterone in “high-” and “low-risk” metastatic hormone-sensitive prostate cancer.European Urology. 2019; 76:719-728. doi:10.1016/j.eururo.2019.08.006Fizazi K, Tran N, Fein L, et al.Abiraterone acetate plus prednisone in patients with newly diagnosed high-risk metastatic castration-sensitive prostate cancer (LATITUDE): final overall survival analysis of a randomised, double-blind, phase 3 trial.Lancet Oncol. 2019;20(5):686-700. doi:10.1016/S1470-2045(19)30082-8
Lapini A, Caffo O, Pappagallo G et al.Monitoring patients with metastatic hormone-sensitive and metastatic castration-resistant prostate cancer: a multidisciplinary consensus Document.Cancers (Basel). 2019;11(12):1908. doi:10.3390/cancers11121908
Henriquez I, Spratt D, Gómez-Iturriaga A, Abuchaibe O, Couñago F.Nonmetastatic castration-resistant prostate cancer: Novel agents to treat a lethal disease. World J Clin Oncol. 2021 Jan 24;12(1):6-12. doi: 10.5306/wjco.v12.i1.6.
American Cancer Society.Key statistics for prostate cancer.
Teo M, Rathkopf D, Kantoff P.Treatment of advanced prostate cancer.Annu Rev Med. 2019;70(1):479-499. doi:10.1146/annurev-med-051517-011947
Urology Care Foundation.What is advanced prostate cancer?
American Cancer Society.Tests to diagnose and stage prostate cancer.
American Cancer Society.Survival rates for prostate cancer.
Damodaran S, Kyriakopoulos C, Jarrard D.Newly diagnosed metastatic prostate cancer: has the paradigm changed?Urol Clin North Am. 2017;44(4):611-621. doi:10.1016/j.ucl.2017.07.008
Hoyle AP et al.Abiraterone in “high-” and “low-risk” metastatic hormone-sensitive prostate cancer.European Urology. 2019; 76:719-728. doi:10.1016/j.eururo.2019.08.006
Fizazi K, Tran N, Fein L, et al.Abiraterone acetate plus prednisone in patients with newly diagnosed high-risk metastatic castration-sensitive prostate cancer (LATITUDE): final overall survival analysis of a randomised, double-blind, phase 3 trial.Lancet Oncol. 2019;20(5):686-700. doi:10.1016/S1470-2045(19)30082-8
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