Purpose: To investigate the prognostic role of time to CASTRATION resistance(TTCR) in patients who have received solely Docetaxel chemotherapy regimen(DCR) for CASTRATION resistant prostate cancer(CRPC). Methods: Between Jan 2004 and Dec 2015, data of 162 patients who have received DCR for CRPC were gathered. Patients were divided into three groups according to TTCR: Group 1(≤ 12 months), group 2(13-24 months), and group 3(>24 months). Data of age, clinical stage, Gleason grade(GG), previous treatments, site of metastases, Prostate-specific antigen (PSA) values, TTCR, overall survival, biochemical progression free survival(PFS) and PSA response to docetaxel were recorded. Result: The mean age of the 162 patients was 74. 4 ± 8. 5 years. Data on mean age, type of CASTRATION, adding estramustine to docetaxel, secondary hormonal manipulation, Gleason grade, clinical T stage at initial diagnosis and site of metastases were comparable between three groups. PSA values were higher in group 1 than other groups. PSA response to docetaxel was 59. 2% in all patient and it was worse in group 1 than other groups (P =. 009). Two years overall survival rates were 7. 6%, 25% and 32. 3% in group 1, 2 and 3, respectively. Median survival rates were 7, 14 and 23 months in group 1, 2 and 3, respectively, and this difference was statistically significant (P=. 016). On multivariate analysis, TTCR was found to be independent prognostic factor for overall survival and response to docetaxel treatment. Conclusion: TTCR appears to be an independent prognostic factor for patients who are candidates for DCR.

Introduction: Orbital metastasis of prostate cancer (PC) is very rare and even more unique in CASTRATION-resistant PC (CRPC). In this scenario, choline positron emission tomography/computed tomography (choline PET/CT) is the gold-standard restaging method of choice available in our setting, and new anti-androgens treatments show improvement in overall survival. Case presentation: We report the case of a 69-year-old male patient diagnosed with PC, treated with radical prostatectomy, and salvage radiotherapy after biochemical recurrence. After new prostate-specific antigen (PSA) progression, androgen deprivation therapy (ADT) was started. Four and a half years later, and already labeled as non-metastatic CRPC with a negative extension study, including choline PET/CT, he developed an accidental left frontal head trauma, presenting with proptosis, palpebral oedema, and oculomotor disorder. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a destructive bone lesion in the left orbit, associated with a soft tissue mass. These findings, suggestive of a neoplastic lesion, were histologically confirmed PC metastasis. Treatment was initiated with abiraterone, with a rapid improvement of symptoms, a progressive decrease of PSA, and a significant radiological response. Conclusion: Orbital metastases may present with proptosis and should be considered in patients with a history of cancer. If the ocular-orbital disease is suspected, the nuclear medicine physician should be aware that the choline PET/CT imaging includes the orbits. Tolerability and response to treatment with abiraterone were excellent.

Several studies indicate that testosterone has a role in pain nociception. Recently, we have shown that CASTRATION and flutamide induced analgesia in the male rats using formalin test. This analgesic effect correlated with increase of serotonin in dorsal horn of the spinal cord. The aim of this study is to investigate the effect of chronic administration of fluoxetine on CASTRATION and flutamide induced analgesia. Four weeks after CASTRATION, we observed analgesia in the second phase of formalin test. Also, Flutamide (10 mg/kg, i.p.), as a testosterone receptor antagonist, induced analgesic effect. Fluoxetine (0.16 mg/kg, i.p. for 5 days) potentiated the analgesic effect of CASTRATION and flutamide. The results indicat that CASTRATION and flutamide produce analgesia which can be potentiated by co-administraion with chronic adminstration of fluoxetine. This study substantiates our previous report showing a correlation between testosterone and serotoninergic system. However, the exact mechanism of testosterone interaction with serotoninergic system is not clear and remains to be elucidated.

Background: The secretion of thyroxine (T4) as the main hormone of thyroid gland is regulated by androgens. The present study aimed to evaluate the effect of testosterone and finasteride administration and CASTRATION on serum levels of T4 and to show the effect of this regulation on total body weight, weight of testis, and the weight of prostate.Methods: Male adult rats (n=32) were divided into 4 groups (n=8): Group 1 (control), Group 2 (CASTRATION), Group 3 (finasteride: 20 mg/kg/day) and Group 4 (testosterone: 5 mg/kg/day). At the end of the study (35 days), serum level of thyroxine, body weight, weight of testis, and prostate were determined.Results: The data showed that the body weight increased in castrated (P=0.04) and decreased in testosterone (P=0.00) groups but did not differ in finasteride (P>0.05) group. There were not any differences in the weight of testis among control, finasteride, and testosterone groups but the weight of prostate increased in testosterone group (P=0.00) and decreased in castrated (P=0.03) and finasteride groups (P=0.04). In addition, the serum level of T4 (nmo/ml) decreased in the three groups: finasteride (P=0.03), testosterone (P=0.04), and castrated (P=0.00).Conclusion: Testosterone in both high and low levels decreased the amount of T4 with a time-dependent manner.

Cancer constitutes a huge burden on societies in countries with any level of economic development. Prostate cancer is the first most diagnosed cancer of men in developed countries and the forth one in developing countries in terms of incidence rate. It is also the third incident cancer of men in Iran along with a prevalence of about 10, 000 cases. CASTRATION-resistant prostate cancer (CRPC) is a severe stage of the disease with a number of newly discovered treatment options. These therapeutic alternatives including abiraterone acetate, enzalutamide, cabazitaxel, immunotherapy with sipuleucel-T, radiopharmaceuticals and bone-targeted therapies (zoledronic acid, denosumab) along with docetaxel have made the decision making process complex and challenging for clinicians. In addition to the challenges of selecting the best-fit treatment, high costs of new pharmaceuticals and technologies necessitates the health policy-makers to develop practice guidelines in adaptation with local resources and limitations. The aim of this paper is to review the clinical guidelines for the management of CRPC. For better comprehension of guideline recommendations, the main clinical trials on new treatments were also identified. The efficacy and safety outcomes including but not limited to overall survival, progression free survival, quality of life and adverse effects were summarized. The guidelines of American Urological Association (AUA), National Comprehensive Cancer Network (NCCN), European Association of Urology (EUA), Spanish Oncology Genitourinary Group (SOGG), Asian Oncology Summit, Saudi Oncology Society-Saudi Urology Association combined guideline, National Institute for Health and Care Excellence (NICE) and Canadian Urological Association-Canadian Urologic Oncology Group (CUA-CUOG) were covered in this paper.