Precision, complexity and stigma in advanced prostate cancer terminology: it is time to move away from ‘castration-resistant’ prostate cancer

The treatment of men with advanced prostate cancer (APC) is changing rapidly, with several new therapeutic options leading to longer survival. Categorizing clinical states that reflect the cancer biology and prior therapy in men with APC has become more complex. The Prostate Cancer Clinical Trials Working Group (PCWG) developed guidelines that harmonized inclusion, monitoring and outcome definitions for clinical trials in APC [1–3]. PCWG2 guidelines were seminal in changing the terminology from 'hormone-refractory' or 'androgen-independent' to 'castration-resistant prostate cancer (CRPC)', based on evidence of men responding to further hormonal manipulations after primary androgen deprivation therapy (ADT). Both of the approved next-generation endocrine agents, abiraterone acetate and enzalutamide, have shown an overall survival benefit for men with progressive cancer despite castrate levels of testosterone [4, 5]. Thus, adopting the term 'castration-resistant' improved the biological accuracy of disease characterization compared with 'hormone refractory'. The term CRPC, although not unanimously accepted, has become embedded in research and clinical practice.

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