Advanced or metastatic prostate cancer initially responds to various types of androgen ablation, but majority of them eventually progress to non-metastatic or metastatic castration-resistant prostate cancer. Among patients with non-metastatic castration resistant prostate cancer, about one-third will develop bone metastasis within 2 years. In treating non-metastatic castration resistant prostate cancer patients, physicians should recognize the heterogeneity of the disease. In the management of advanced metastatic castration resistant prostate cancer patients, pain and quality of life are the predominant factors. In contrast, delaying time to progression is more important in non-metastatic or oligo-metastatic castration resistant prostate cancer groups. The use of medications that are mainly approved for metastatic disease has been shown to provide survival benefit in patients with non-metastatic castration resistant prostate cancer. Therefore, early use of such treatment approaches that target both androgen receptor signaling pathways and alternative oncogenic pathways seem reasonable in non-metastatic castration resistant prostate cancer. However, lack of evidence that depends on randomized trials limits therapeutic options in non-metastatic castration resistant prostate cancer, therefore the patients should be consulted, managed, and treated in a multidisciplinary approach.

Keywords: Castration-resistant prostate cancer, non-metastatic, treatment options