[Management of non metastatic castration resistant prostate cancer]

To review the features of non-metastatic castration resistant prostate cancer (nmCRPC) and analyze the available therapeutic options. A literature search was performed using MEDLINE/Pubmed and EMBASE databases.

Non metastatic CRPC occurs when a properly castrated patient presents a PSA increase without radiological distant metastases. Up to now, the new therapies available for treatment of castration resistant prostate cancer (CRPC) have been tested and approved to be used in patients with distant metastases. Therefore there is a lack of proved effective therapies that have been traditionally covered with second line hormonal maneuvers. A major limitation of studies evaluating hormonal maneuvers is that they had as primary end point PSA decline assesment, generally equal or greater than 50%, on the basis that a response entailed a greater survival. However, and admitting that there is a relationship between PSA progression and survival, nowadays in a clinical trial changes in PSA are not accepted as surrogate for survival. For this reason there are no studies that directly show that second-line hormonal maneuvers prolong survival. Despite the absence of alternatives, some patients especially those worried about PSA progression, can benefit from these maneuvers.

Second-line hormonal maneuvers can be an alternative in the absence of effective therapies, as long as they are well tolerated in well informed patients who refused observation or clinical trial inclusion.