Androgen metabolism in prostate cancer: recent advances

Androgen biosynthesis is physiologically necessary for generating the principal stimulus for androgen receptor (AR) signaling and thus plays an essential role for development of the normal prostate, prostate cancer growth, and the development of resistance to hormonal therapies. Testosterone and dihydrotestosterone are both potent endogenous androgens that stimulate AR signaling. While the role of gonadal androgens in stimulating prostate cancer progression has been recognized for over 80 years, the appreciation for nongonadal precursor steroids in prostate cancer has been more limited in duration of time, attention, and focus in the field. Nevertheless, the very clearly established role of nongonadal androgens in enabling prostate cancer progression, especially in the absence of gonadal testosterone, frames the essentiality of androgen metabolic processes for dictating prostate cancer clinical behavior. Here, the role of androgen metabolism in prostate cancer is reviewed, particularly within the context of hormonal therapy and hormone therapy resistance, and with emphasis on recent advances.