Hormone-Refractory Prostate Cancer

or Castrate-Resistant Prostate Cancer

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DEFINITION OF HRPC

There are differing opinions on the definition of HRPCa. There are also several terms that are used in these discussions:

Hormone-refractory PC (HRPCa)
Hormone-resistant PC (HRPCa)
Androgen-Independent PC (AIPC)
Castration Resistant Prostate Cancer (CRPC) - latest "descriptive phrase"

For this web site and for the support list the term "hormone-refractory prostate cancer" was chosen because it seemed to be the most commonly used designation for this stage of prostate cancer.  Recently, as more is understood, the term "castration-resistant prostate cancer" is commonly being used in the medical community.  See recent explanation in medical literature here. For the time being and for the sake of simplicity, we have chosen to continue to use the term "hormone-refractory prostate cancer".

Dr. Stephen Strum coined the term "androgen-independent prostate cancer," which he defines as follows:

"AIPC is defined as disease progression evidenced by a progressively rising PSA (three consecutive rises of at least 10% each or three rises that involve an increase of 50% over the nadir PSA) or an increase in tumor mass on bone scan, X-ray, CT scan or MRI despite a castrate level of testosterone (T<20 ng/dl)."

He further goes on to say..."if a patientís PSA stops falling and begins to rise on ADT(2) or ADT(3), if the T level is castrate, and if the adrenal androgen precursors (DHEA-S and androstendione) are not low, then AIPC is presumed present until proven otherwise. [Strum, S.B., "Important Principles in Chemotherapy: Regimens Treating Androgen-Independent Prostate Cancer," PCRI INSIGHTS, pp. 10-16, Vol. 2, No. 4, Dec. 1999.]  Note: this paragraph separates out the androgen receptor mutation possibility and the resultant anti-androgen withdrawal effect (declining PSA on stopping an anti-androgen.).

ADT(2) is androgen deprivation therapy with an LHRH agonist and Casodex or Eulexin. ADT(3) is the same plus Proscar. T is testosterone.

Dr. Bob Leibowitz uses the term "hormone-resistant prostate cancer" as follows:

"If, in spite of a testosterone level in the castrate range, the PSA is rising, then we define this as hormone resistant prostate cancer. You might still respond to other hormone manipulations, such as by adding an antiandrogen, if you were on monotherapy alone." [http://www.prostatepointers.org/prostate/leibowitz/leib20.html]

Dr. Leibowitz defines "hormone-refractory prostate cancer" as follows:

"If your PSA rises in spite of all hormone blocking agents (including medicines like Nizoral, aminoglutethimide), then you have HRPC (hormone refractory prostate cancer). Your disease may still respond to other non-hormone treatments." [Ibid.]

In the August 1999 issue of the "Prostate Forum" newsletter, Dr. Charles Myers seems to use the terms hormone-resistant and hormone-refractory interchangeably.

For this web site, at the present time, we use the following working definition of hormone-refractory to decide if an individual is eligible to join the support group:

If an individual has three consecutive increases in his PSA while on hormone blockade, and his testosterone is at a castrate level

(<20 ng/dl), we consider that he is hormone-refractory.

This simplistic definition works because it is necessary to look at the treatments, the PSA levels, and other tests to assess where he falls on the continuum of partial to complete hormone-resistance. Usually it is a doctor who has told the individual that he is hormone-refractory. Our first recommendation to each of these individuals who joins our support group is that he challenge the validity of that assessment by looking at past tests to determine if the testosterone was indeed brought down to castrate levels by the hormone therapy.

Since there is a limited (but growing) number of therapies available following hormone blockade, the important issue is to assess which of those therapies are available for consideration by the individual and his doctor.

Updated 12/26/2008 and 2/5/13

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This information related to HRPCa, AIPC, and/or CRPC is provided for educational purposes only and does not replace or amend professional medical advice. Unless otherwise stated and credited, the content of this website is by and the opinion of and copyright © 2001-2013 Howard Hansen and/or HRPCa Association, Inc.  All Rights Reserved.  Our policy regarding privacy, right to reprint and contact information are at About Us. We are a 501(c)(3) not-for-profit public charity.