Despite aggressive treatment and androgen-deprivation therapy, most prostate cancer patients ultimately develop castration-resistant prostate cancer (CRPC), which is associated with high mortality rates. However, the mechanisms governing the development of CRPC are poorly understood, and androgen receptor (AR) signaling has been shown to be important in CRPC through AR gene mutations, gene overexpression, co-regulatory factors, AR shear variants, and androgen resynthesis. A growing number of non-AR pathways have also been shown to influence the CRPC progression, including the Wnt and Hh pathways. Moreover, non-coding RNAs have been identified as important regulators of the CRPC pathogenesis. The present review provides an overview of the relevant literature pertaining to the mechanisms governing the molecular acquisition of castration resistance in prostate cancer, providing a foundation for future, targeted therapeutic efforts.

Background Whether cytoreductive prostatectomy (CRP) should be performed in patients with oligometastatic prostate cancer (OPC) remains controversial. The goal of this systematic meta-analysis was to assess the efficacy of CRP as a treatment for OPC. Methods This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Data sources included publications in the PubMed, Embase, the Cochrane Library, EBSCO, and Web of Science (SCI) databases as of May 2022. Eligible articles included prospective studies comparing the efficacy of CRP to a lack of CRP in patients with OPC. Results In total, 10 publications incorporating 888 patients were analyzed. Tumor-reducing prostatectomy was found to have no significant effect on long-term or short-term OS [OR = 2.26, 95% CI (0.97, 5.28), P = 0.06] and [OR = 1.73, 95% CI (0.83, 3.58), P = 0.14], but it significantly improved patient long-term or short-term CSS [OR = 1.77, 95% CI (1.01, 310), P = 0.04] and [OR = 2.71, 95% CI (1.72, 4.29), P < 0.0001] and PFS [OR = 1.93, 95% CI (1.25, 2.97), P = 0.003]. Conclusion These results suggest that cytoreductive prostatectomy can confer survival benefits to OPC patients. Trial registration INPLASY protocol 202260017 https://doi.org/10.37766/inplasy2022.6.0017.

Objective: To explore the current therapies on castration-resistant prostate cancer (CRPC), such as drug therapy and radiotherapy.Recent Advances: Currently, CRPC is an incurable disease. CRPC treatment options available can only relieve symptoms and prolong the survival time. Because of the in-depth study of resistance mechanisms, various new drugs have been reported, including androgen synthetic inhibitor, abiraterone. Novel targeted therapy and immunotherapy have been thoroughly investigated. The recent advances in wellstudied radiotherapy and chemotherapy against CRCP have also been reviewed. In this review, we have summarized new generation hormone drugs (e.g., abiraterone, enzalutamid), chemotherapeutic drugs (docetaxel), targeted therapy drugs, immunotherapy drugs (Sipulecel-T), and radioactive drugs (Radium 223). The overall treatment goals include to prolong OS, to improve quality of life, to relieve symptoms, and to prevent complications in CRCP patients. Conclusions:The use of drug therapy in combination with other drugs might improve the efficacy of CRPC treatment and might help overcome drug resistance.