Castrate Resistance Prostate Cancer


Stage III and Stage IV diagnoses of prostate cancer represents an advanced stage of disease progression. Specifically, castrate-resistance prostate cancer (CRPC) is a complex form of locally advanced or metastatic prostate cancer which is hormone resistant, thus unable to be treated through surgery or androgen-deprivation therapy. The non-responsive nature of CRPC has historically rendered patients in this category with very poor survival rates, and very limited treatment options. Traditionally, patients with CRPC are treated with chemotherapy (a cytotoxic therapy), however patients can also be chemotherapy naïve, and thus other forms of treatment have been developed to target CRPC through other mechanisms.

Novel pharmacological agents enzalutamide and abiraterone have been developed to target androgen-receptors (a second-line hormonal manipulation), with initial evidence showing promising outcomes by suppressing androgen signalling in blood and bone marrow, which is particularly helpful for men with bone metastases. These two agents are often provided simultaneously to capitalise on their different yet complimentary mechanisms. This is a relatively new therapeutic approach for advanced stage, chemotherapy naïve, metastatic prostate cancer patients.

Exercise Implications

Exercise remains very relevant to your health, even at this advanced stage of disease progression, and is strongly recommended for various important reasons. Firstly, exercise has been shown to improve your tolerance to chemotherapy treatment by reducing the severity of potential side-effects you could otherwise experience. Secondly, exercise has been shown to increase blood flow and delivery to tumours, which has a two-fold anti-cancer benefit: 1) it helps interfere with tumour growth (as tumours thrive in hypoxic environments), and 2) it helps chemotherapeutic delivery of drug treatments directly into the tumour site, thus increasing the effectiveness of chemotherapy. Thirdly, emerging evidence is beginning to provide an insight into the safety of directly exercising tumour sites to slow tumour invasion and spread with anti-cancer effects; reducing tumour growth by interfering with tumour-driven remodelling in bone.

Lastly, exercise in these advanced stages can help prevent muscle and bone loss, maintain good body composition, and ultimately assist you with improving physical function, independence and psychosocial wellbeing. Exercise can also help you with reducing symptoms resulting from the various combinations of potential treatments provided to you, including enzalutamide and abiraterone if administered. Given the many benefits to your health and wellbeing, we strongly recommend you engage in exercise. You will require modified exercise programs, and should read through our Special Program section, prior to seeking approval from your consulting physician. It is important that you discuss your medical limitations with your physician prior to meeting with your accredited exercise physiologist who specialises in cancer management. Exercise can be safely performed with appropriately written and supervised programs.