Defining advanced
prostate cancer (aPC)  

Advanced prostate cancer is defined and classified based on progression

Advanced prostate cancer is cancer that has spread beyond the prostate gland. It can be locally advanced or metastatic (spread to distant parts of the body).1

Progressing from localized to advanced prostate cancer 

It is important to understand whether a patient’s prostate cancer is stable or progressing. Some men respond to surgery or radiation and don’t need further treatment, but for some men,
the cancer may progress at some point. Progression may present as2:
  • A continuous rise in prostate-specific antigen (PSA) levels (values identified at a minimum of 1-week intervals with
    a minimal value of 2.0 ng/mL, with estimations of PSA doubling time with at least 3 values measured ≥4 weeks apart)
  • The progression of pre-existing or new radiographic disease
  • And/or clinical progression with symptoms
Progression may take one of the following routes as shown below.3
Flowchart showing progression from localized prostate cancer to biochemical recurrence, then branching to mCSPC, nmCRPC, and mCRPC prostate cancer states. Localized Prostate Cancer Biochemical Recurrence or PSA Failure mCSPC nmCRPC mCRPC
Flowchart showing progression from localized prostate cancer to biochemical recurrence, then branching to mCSPC, nmCRPC, and mCRPC prostate cancer states. Localized 
Prostate Cancer Biochemical Recurrence or 
PSA Failure mCSPC nmCRPC mCRPC

Classifying advanced prostate cancer 

The following criteria define the different types of aPC:
Biochemical recurrence indicates a worsening of prostate cancer and may be associated with progression to advanced prostate cancer. Biochemical recurrence includes2:
  • Rise in PSA after treatment with surgery or radiation
  • PSA of 0.2 ng/mL and a confirmatory value of ≥0.2 ng/mL following radical prostatectomy and nadir + 2.0 ng/mL following radiation
  • May occur in patients who do not have symptoms
Advanced prostate cancer is classified based on responsiveness to hormone therapy and metastatic status:
  • Castration-sensitive prostate cancer (CSPC)2
    • Less commonly referred to as hormone-sensitive prostate cancer (HSPC), endocrine-sensitive prostate cancer, and hormone-naïve prostate cancer. It is characterized by cancer that has either not yet been treated with androgen deprivation therapy (ADT) or is still responsive to ADT as evidenced by absence of progression, meaning PSA levels are low and testosterone is at castration levels.
    • Can be nonmetastatic (nmCSPC) or metastatic (mCSPC)4
      • nmCSPC is prostate cancer that is still responsive to hormone therapy and shows no evidence of metastasis on conventional imaging, but may have spread to the regional lymph node
      • mCSPC is prostate cancer that is still responsive to ADT and has metastasized to distant parts of the body 
  • Castration-resistant prostate cancer (CRPC)2,5,6
    • Defined by disease progression meaning PSA levels are rising, despite ADT and a castrate level of testosterone (<50 ng/dL)
    • Can be nonmetastatic (nmCRPC) or metastatic (mCRPC)
      • nmCRPC is prostate cancer that is no longer responding to hormone therapy but has not yet spread to other parts of the body
      • mCRPC is prostate cancer that has spread beyond the prostate gland and is also resistant to hormone therapy
A doctor discusses information on a tablet with an older male patient who appears thoughtful; both are seated indoors.
Table comparing mCSPC, nmCRPC, and mCRPC based on cancer spread and response to ADT; only mCSPC checks both spread and response, mCRPC only spread, nmCRPC neither. Classifying Criteria Has spread to other parts of the body Still responds (via lowering PSA while on ADT) mCRPC nmCRPC mCSPC Nonmetastatic Castration - Resistant Prostate Cancer Metastatic Castration - Resistant Prostate Cancer Metastatic Castration - Sensitive Prostate Cancer

Classifying aPC

Classifying aPC

Download a printable quick-reference guide about classifying advanced prostate cancer to use in-office.
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