Nonmetastatic castration-resistant prostate cancer is a type of the disease, and about 10 to 20 percent of prostate cancer cases are castration-resistant, according to Oncology Times. Men with nonmetastatic castration-resistant prostate cancer no longer respond to the hormone therapy used to curb the growth of the disease, and they are at risk of metastasis, which is when cancer spreads to other parts of the body. Typically, in these cases, these events have occurred: (2)
The original tumor has been removed surgically or using radiation.Hormone therapy, also known as androgen deprivation therapy (ADT), has been prescribed to cut off the supply of testosterone, a hormone that can trigger the growth of prostate cancer cells that remain in the body.Blood tests show that the level of prostate-specific antigen (PSA), a protein made by prostate cancer cells, is rising, despite hormone therapy, suggesting resistance to the therapy.The cancer doesn’t yet show signs of metastasis on imaging tests.
How Did This Type of Prostate Cancer Get Its Name?
When PSA levels increase after treatment with ADT, it’s called “castration-resistant disease.” (The use of the word ”castration” in this context means that, with ADT, testosterone levels are as low as what is seen if the testicles are removed.) If imaging tests, such as bone scans and computed tomography (CT) scans, show that the cancer hasn’t spread, it’s referred to as “nonmetastatic castration-resistant prostate cancer.” (3) RELATED: What Is PSA?
Does Nonmetastatic Castration-Resistant Prostate Cancer Have Symptoms?
The symptoms of nonmetastatic castration-resistant prostate cancer may include these signs: (4)
Trouble getting or maintaining an erectionLoss of interest in sexPainful ejaculationHot flashesUrinary incontinenceFrequent or painful urinationConstipationBlood in the urineFatigue
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How Will I Know if I Have Nonmetastatic Castration-Resistant Prostate Cancer?
Most cases of prostate cancer that are not cured with surgery or radiation will eventually become resistant to the effects of hormone therapy. If this happens, your PSA level might start to rise. A rising PSA level could mean that the cancer is progressing. (5) Your PSA can be measured with a simple blood test. Your doctor will likely test your PSA level periodically while you are receiving hormone therapy to gauge how well you are responding to it. A widely accepted definition for “rising PSA levels” is a 25 percent increase from the lowest point, with a minimum surge of 2 nanograms per milliliter. This rise must be confirmed one to three weeks later. (3) If your PSA level is rising, your doctor will order scans to see if there is evidence that the prostate cancer has spread somewhere else in your body. RELATED: 5 Ways to Boost Your Quality of Life During Prostate Cancer Treatment
What Are My Treatment Options?
Until recently, nonmetastatic castration-resistant prostate cancer was either watched carefully until it progressed further or was continued on treatment with ADT. (3) In 2018, two new therapies — enzalutamide (Xtandi) and apalutamide (Erleada) — were approved by the Food and Drug Administration to treat nonmetastatic castration-resistant prostate cancer. (6,7) Since then darolutamide (Nubeqa) has also been approved as per National Comprehensive Cancer Network (NCCN) guidelines.
Enzalutamide Enzalutamide is an androgen receptor inhibitor that works by interfering with the connection between androgens (a group of hormones that includes testosterone) and androgen receptors on prostate cancer cells to slow cancer cell growth. In a clinical trial of 1,401 men with nonmetastatic castration-resistant prostate cancer, researchers found that adding enzalutamide to ADT therapy delayed the time to metastatic disease or death by almost 22 months. Enzalutamide also prolonged the time before men needed other cancer therapies. Enzalutamide comes as a capsule that you take once a day. ( 8)Apalutamide Apalutamide is another androgen receptor inhibitor that works by blocking androgens from attaching to receptors. In a clinical trial, investigators looked at a group of 1,207 men with nonmetastatic castration-resistant prostate cancer and discovered that adding apalutamide to whatever treatment the men were currently undergoing delayed the time to metastasis by more than 24 months on average. Apalutamide comes in tablet form. ( 9)
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Prognosis: New Therapies Prolong Survival
If your disease progresses to the point of metastasis, the prognosis is poor, with an average survival of about three years with medical therapy. Doctors aim to delay metastasis in men with nonmetastatic castration-resistant prostate cancer. If you can delay the time it takes for the cancer to metastasize, however, you can help prolong your survival. For men with prostate cancer, the most common sites for metastasis are the bones, lymph nodes, lungs, and liver.
