Figure 2.

Treatment of prostate cancer over its disease course. The initial stage of prostate cancer involves prostate-confined disease, referred to as local or nonmetastatic disease; local disease is treated with surgery or radiation and is surveilled for recurrence. Recurrent or metastatic disease if caught early is normally castration-sensitive and is thus treated with surgical or chemical androgen deprivation therapy (ADT). ADT is the foundation of prostate cancer treatment throughout the disease course. Prostate cancer eventually becomes castration-resistant when the disease no longer responds to ADT (denoted by blue gradient). Castration-resistant prostate cancer is often subsequently treated with androgen biosynthesis inhibitors (ABI), antiandrogens (AA), or taxanes (Tx). New therapies for metastatic castration-resistant prostate cancer include immunotherapy (I), radiopharmaceuticals (R), and PARP inhibitors (PI). Prostate cancer can metastasize during either the castration-resistant or castration-sensitive phase (denoted by the pink gradient). Metastasis becomes more likely as the disease progresses and alters the treatment of the cancer. Therapies impacting bone mass (denoted by underlining) are given throughout the disease.