Episode 1 - Defining and Detecting CRPC

Christopher Sweeney, MBBS, provides an overview of castration-resistant prostate cancer (CRPC) and discusses criteria that clinicians consider when making decisions about treatment for patients who experience disease progression.

Dr Sweeney, an associate professor in the department of medicine at Harvard Medical School and a medical oncologist at the Dana-Farber Cancer Institute, explains that CRPC is diagnosed when a patient experiences disease progression despite being treated with androgen deprivation therapy (hormonal therapy). An increase in PSA despite hormonal therapy may indicate disease progression.

Dr Sweeney notes that testosterone levels are considered suppressed if less than 50 ng/dL, and comments that lower levels may be better. If a patient’s testosterone is not adequately suppressed on one hormonal therapy agent, an alternative agent may be considered. If a patient does not respond to hormonal therapy, surgical castration may be recommended.

With hormonal therapy, Dr Sweeney notes that time to disease progression varies widely, and can range from months to years. He explains that the extent of disease at presentation is correlated with time to progression and overall survival. He adds that patients who have lower levels of PSA while on hormonal therapy experience disease control for longer periods of time.

Watch our related Peer Exchange, Oncology Stakeholder Summit 2014: Evidence-Based Decisions to Improve Quality and Regulate Costs