ADVANCED PROSTATE CANCER

 

The following is a commentary and a set of definitions which Mike Scott posted on The "New" Prostate Cancer InfoLink Social Network in reference to a discussion about terminology in advanced prostate cancer. They may be helpful for some men who are concerned about their diagnosis or treatment options.

There are very specific and differentiable categories of "advanced" prostate cancer, and it is important to be careful to classify them so that people are clear about the differences. What PATIENTS may want to call these (as opposed to what clinicians may want to call them) is important, but let me see if we can get the basics down first:

"Advanced prostate cancer" is any form of prostate cancer that has probably or actually escaped from the prostate and the immediate region of the tissues surrounding the prostate, even if there is no specific evidence of micrometastasis or metastasis, and regardless of the forms of treatment the patient may have received.

"Lymph-node positive prostate cancer" (clinical stage N1) is prostate cancer that has progressed into the regional pelvic lymph nodes. Arguably this is not an advanced form of the disease, but my belief is that 90 percent of lymph node-positive prostate cancer is also micrometastatic prostate cancer (see below).

"Hormone-refractory prostate cancer" is usually defined as prostate cancer that is longer being controlled by first-line hormonal therapy, as indicated by a rising PSA (regardless of the patient's clinical stage or evidence of metastasis).

"Androgen-independent" or "Castration-resistant prostate cancer" is usually defined as prostate cancer that is no longer responding to any "standard" form of hormonal therapy such as LHRH agonists or antagonists, antiandrogens, estrogens, or even Ketaconzole (regardless of the patient's clinical stage or evidence of metastasis). Note that with the coming of Abiraterone, we may have to redefine this expectation since Abiraterone is in fact a form of hormonal therapy.

"Micrometastatic prostate cancer" (clinical stage NxMo) is cancer in which it is clear from the patient's history and clinical signs (e.g., a rising PSA after first-line surgery and second-line radiation) that the cancer has metastasized, even though there is no actual evidence of metastatic disease.

"Metastatic prostate cancer" (clinical stage NxM1) is cancer in which there is clear evidence of metastasis to the bones or other tissues on the basis of some form of imaging scan (bone scan, CT scan, MRI).

"Taxane-resistant prostate cancer" is cancer that has stopped responding to docetaxel-based chemotherapy (or chemotherapy based on some other form of taxane).