What’s in a Name? Why Words Matter in Advanced Prostate Cancer

Abstract

Section snippets

Metastatic hormone-sensitive prostate cancer (mHSPC)

The debate concerning the scientific accuracy and negative connotations of the word “castration” for patients has been discussed previously [3], [4] and is clearly a prominent example of the powers—positive and negative—mentioned above. In particular, we believe that the word “castration” is difficult for patients, partners, and families to hear and should be avoided when we describe this advanced prostate cancer disease state. mHSPC is the most common term for patients with newly diagnosed

Androgen deprivation–resistant prostate cancer (ARPC)

One widely used term is “castration-resistant” prostate cancer. Since all patients with this disease state are resistant to androgen deprivation, we propose a new term: androgen deprivation–resistant prostate cancer (ARPC).

Androgen receptor pathway inhibitors (ARPI)

The class of androgen receptor (AR) pathway inhibitors (eg, abiraterone acetate, apalutamide, darolutamide, enzalutamide) appears to have many names, going back decades to the first “anti-androgens” such as bicalutamide. Currently, various terms such as AR signaling inhibitors (ARSI), novel hormonal therapies (NHT), AR-targeted agents (ARTA), and second- or next-generation hormonal therapies are all used. Unfortunately, this nomenclature is not only confusing but is also prone to becoming

Combination therapy for mHSPC (ADT plus ARPI +/- docetaxel)

Multiple randomized trials have demonstrated superior overall survival in mHSPC with the addition of an ARPI to ADT (“doublet therapy”) or an ARPI to ADT and docetaxel chemotherapy (“triplet therapy”) [6], [7]. Describing regimens comprising two or three drugs as doublets or triplets may be descriptive but can easily be misinterpreted. For instance, the term “triplet therapy” in mHSPC has been used to describe ADT + ARPI + radiation therapy to the prostate by some investigators. Future