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2012, Número 1

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RCU 2012; 1 (1)


El cáncer de próstata resistente a castración. Mecanismos de progresión y nuevos tratamientos

Moro SA, Laborí CC, Bouzó LA, González HJ

Idioma: Español
Referencias bibliográficas: 53
Paginas: 106-122
Archivo PDF: 427.28 Kb.


RESUMEN

El cáncer de próstata es un problema de salud en Cuba y otras partes del mundo occidental. La comprensión de la función esencial que los andrógenos tienen en la fisiología de la próstata guió al desarrollo del bloqueo hormonal como opción de tratamiento para la enfermedad avanzada, con una respuesta de aproximadamente el 80 % de los pacientes. Sin embargo, esta respuesta es limitada ya que se puede desarrollar resistencia entre los 12 y los 33 meses posteriores al inicio del mismo. Cáncer de próstata resistente a la castración de andrógenos (CPRC) es el término utilizado para esta etapa y está asociado con mal pronóstico ya que la supervivencia a partir de este momento oscila entre los 18 y los 24 meses. Aún con niveles de castración, los tumores son dependientes del receptor de andrógenos (RA) funcional. En el presente trabajo se abordan algunos de los mecanismos moleculares que se proponen para explicar este fenómeno. Se incluyen: 1) la sobre-expresión/amplificación del RA; 2) mutaciones en el RA; 3) producción localmente aumentada del andrógeno por las células tumorales; 4) activación del RA por ligandos no esteroides; 5) expresión aberrante de co-activadores o co-represores, 6) el procesamiento proteolítico del RA para generar una isoforma que es andrógeno independiente y 7) el efecto de los microÁcidos Ribonucleicos (microARNs) Actualmente los tratamientos aprobados para los pacientes con CPRC incluyen a la mitoxantrona, isótopos radioactivos, el ácido zoledrónico, el docetaxel y el sipuleucel T. Aquí describimos nuevos fármacos que pudieran ser de gran interés para nuestros urólogos.


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