Treatment of metastatic castration-resistant prostate cancer (mCRPC): abiraterone acetate as the first choice

Treatment options in the care of patients with malignant prostate tumours have expanded significantly in the recent years. Local therapy,

whether surgical or radiation, and watchful waiting are suitable options for localized disease. Advanced diseases can no longer be cured,

but in combination with local therapy, particularly radiation therapy, advanced tumours can be affected therapeutically by adding hormonal

therapy. For generalized disease, systemic hormonal therapy is the treatment of choice. A response to hormonal therapy can be

expected in more than 80% of patients with generalized disease. The duration of the response varies. The disease progresses gradually

and, despite castration testosterone levels, becomes castration-resistant prostate cancer (CRPC). Different growth characteristics of

tumour cells in CRPC allow cytotoxic treatment. Administration of docetaxel in a 3-week regimen results in prolonged survival, but the

duration of the response is limited. In recent years, we have witnessed the advent of novel agents, both those affecting bone metabolism

as well as new-generation cytotoxic and hormonal ones. Gradually, these drugs are included in the treatment algorithms for patients

with metastatic CRPC. Their use is limited by the regulatory agency measures based on the outcomes of registration studies. Initially, all

the novel agents were used following previous chemotherapy with docetaxel and were considered second-line treatment. Today, it is

possible to administer second-generation hormonal agents in chemonaive patients as well. The treatment of mCRPC is headed toward

highly individualized care of the particular patient.

Keywords: abiraterone acetate, prostate cancer, mCRPC