Spiral model for prostate cancer progression. The first phase is the DHT-dependent phase. The second phase is the microenvironment-dependent phase.
The third phase is the cell-autonomous phase. Each “turn” is defined by a predictive marker(s) that can be targeted. The pitch in each spiral reflects the
duration that the tumors remain responsive to a specific therapy. The adaptive changes in tumors in response to therapy account for resistance, leading
the tumor to progress to the next turn of the progression spiral, which signals additional alterations in the tumor and its microenvironment. Tumors in this
new “turn” will require different therapeutics that specifically target the altered properties that define the turn. Markers that reflect the biology that drives
each turn can be used to guide timely therapy application in anticipation of progression. DHT, dihydrotesterone; AR, Androgen Receptor; IGF, Insulin Like
Source: Prostate Cancer, The MD Anderson Manual of Medical Oncology, 3e
Growth Factor; FGF, Fibroblast Growth Factor. (Reproduced with permission from Logothetis CJ, Gallick GE, Maity SN, et al. Molecular classification of
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Kantarjian
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The MD Anderson
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3e; 2016
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