Harvard Perspectives on Prostate Disease

Androgen-independent prostate cancer

When cancer advances despite primary hormone therapy

We often hear the term prostate cancer and assume it is one disease. Practically speaking, it is. On a molecular level, however, scientists are revealing a far more complex picture. Cancer has an innate ability to adapt to its surroundings. As it progresses, cancer cells tend to change, morphing to a point where the differences between tumor cells can be dramatic. That's why some researchers believe late-stage prostate cancer is more accurately described as a mix of cancer cell types.

Each year, an estimated 25,000 men will find out their prostate cancer has changed enough to become resistant to standard androgen-deprivation therapy, also called hormone therapy. At this point, the cancer is classified as androgen-independent prostate cancer (AIPC) or hormone-refractory prostate cancer, meaning that the cancer is still able to thrive despite hormone treatment.* The first sign of AIPC is typically a rising PSA level, a shift that can be extremely distressing for patients, but not entirely unexpected. A majority of patients with AIPC will have already watched their PSA levels rise at two previous critical junctures: before their initial cancer diagnosis and after supposedly curative local treatment. When PSA levels rise again, despite primary hormone therapy, it represents a third critical decision-making point for patients.

*Editor's note: The terms androgen-independent and hormone-refractory are evolving. Many experts, including our roundtable participants, use terms such as castration resistant and primary hormone-therapy resistant instead. For the sake of clarity, this article will use androgen-independent prostate cancer.

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