Novel Therapeutic Approaches for Metastatic Castrate Resistant Prostate Cancer

Metastatic prostate cancer remains an incurable disease since novel antiandrogens mildly increase the survival of patients leading to a stage with very limited therapeutic options. Rapidly proliferating prostate cancer cells maintain survival under hormonal therapy through activation of alternative oncogenic signaling regulating cellular activities mediating growth, proliferation and migration. Anabolic activities regulated by oncogenic pathways such as c-Myc and Akt have been found to promote prostate cancer growth and targeting aerobic glycolysis and lipid synthesis have been proposed as novel therapeutic approaches for patients with metastatic hormonal resistant prostate cancer. Rapid proliferation of progressive disease is associated with accumulation of DNA damage rendering inhibition of DNA damage repair pathways a particularly effective approach to target aggressive hormonal resistant disease. The supply of oxygen and nutrients is critical for the survival and growth of proliferative and aggressive disease rendering angiogenesis a highly important aspect of cancer cells' survival in this stage of disease. The aim of this review was to summarize the current knowledge about targeting these three pathways in the metastatic hormonal resistant prostate cancer.