Androgen Receptor Signaling in Prostate Cancer and Therapeutic Strategies

Aasems Jacob1, Rishi Raj2, Derek B Allison3,4,5

  • 1Department of Medicine, Division of Hematology & Oncology, Pikeville Medical Center, Pikeville, KY 41501, USA.

Cancers
|November 13, 2021
PubMed

Insights

Prostate cancer therapies targeting androgen receptor (AR) show promise but resistance develops. Understanding AR-dependent and independent resistance mechanisms is crucial for developing new treatments.

Area of Science:

  • Oncology
  • Molecular Biology
  • Pharmacology

Background:

  • Prostate cancer treatment often involves targeting the androgen receptor (AR) signaling pathway.
  • Androgen-receptor signaling inhibitors (ARSIs) like abiraterone, enzalutamide, apalutamide, and darolutamide have improved survival.
  • However, drug resistance invariably develops, limiting long-term efficacy.

Purpose of the Study:

  • To elucidate the molecular mechanisms underlying resistance to ARSIs in prostate cancer.
  • To identify both androgen-dependent and androgen-independent pathways that mediate treatment failure.
  • To inform the development of novel therapeutic strategies to overcome resistance.

Main Methods:

  • Review of current literature on prostate cancer molecular mechanisms and therapeutic resistance.
  • Analysis of known AR-dependent resistance pathways, including AR splice variants (e.g., AR-V7), overexpression, and mutations.
  • Investigation of non-AR-dependent resistance mechanisms involving alternative signaling pathways.

Main Results:

  • Resistance can occur through AR-dependent mechanisms, such as AR splice variants (AR-V7) or mutations, which are not targeted by current ARSIs.
  • Androgen-independent resistance involves the activation of alternative signaling pathways, including DNA repair, PI3K/AKT/mTOR, BRAF-MAPK, Wnt, and glucocorticoid receptor pathways.
  • These alternative pathways can restore downstream signaling, bypassing AR inhibition.

Conclusions:

  • Resistance to ARSIs in prostate cancer is a complex process involving multiple molecular mechanisms.
  • Targeting AR-V7 and exploring inhibitors of alternative signaling pathways are critical areas for future research.
  • Ongoing clinical trials aim to develop strategies to overcome these resistance mechanisms and improve patient outcomes.

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