Abstract
Simple SummaryProstate cancer is the second most common cancer in men world-wide, with nearly 1.3 million new cases each year, and over the next twenty years the incidence and death rate are predicted to nearly double. For decades, this lethal disease has been more or less successfully treated using hormonal therapy, which has the ultimate aim of inhibiting androgen signalling. However, prostate tumours can evade such hormonal therapies in a number of different ways and therapy resistant disease, so-called castration-resistant prostate cancer (CRPC) is the major clinical problem. Somewhat counterintuitively, the androgen receptor remains a key therapy target in CRPC. Here, we explain why this is the case and summarise both new hormone therapy strategies and the recent advances in knowledge of androgen receptor structure and function that underpin them.Prostate cancer (PCa) is the most common cancer in men in the West, other than skin cancer, accounting for over a quarter of cancer diagnoses in US men. In a seminal paper from 1941, Huggins and Hodges demonstrated that prostate tumours and metastatic disease were sensitive to the presence or absence of androgenic hormones. The first hormonal therapy for PCa was thus castration. In the subsequent eighty years, targeting the androgen signalling axis, where possible using drugs rather than surgery, has been a mainstay in the treatment of advanced and metastatic disease. Androgens signal via the androgen receptor, a ligand-activated transcription factor, which is the direct target of many such drugs. In this review we discuss the role of the androgen receptor in PCa and how the combination of structural information and functional screenings is continuing to be used for the discovery of new drug to switch off the receptor or modify its function in cancer cells.
Highlights
Prostate cancer (PCa) is the second most common cancer in men world-wide, with nearly 1.3 million new cases each year [1]
In the USA, 1 in 41 men will die of PCa [2]
While this increase is seen in most regions of the world, it is predicted to be highest in Latin America/Caribbean, Africa and Asia [3]
Summary
Prostate cancer (PCa) is the second most common cancer in men world-wide, with nearly 1.3 million new cases each year [1]. In the USA, 1 in 41 men will die of PCa [2] While this increase is seen in most regions of the world, it is predicted to be highest in Latin America/Caribbean, Africa and Asia [3]. PCa is not a new disease and there are an increasing number of detailed analyses of archaeological samples that reveal evidence of metastatic PCa in the ancient world (Figure 1) [4,5,6,7]. Metastatic disease must be treated systemically and here the role of the androgen receptor (AR) becomes paramount
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