This is the prostate cancer natural history. As you can see in the figure it progresses very slowly and the patient may survive for years after diagnosis.
The first peak correlates with localized disease and is treated with local therapy in most of the cases. We will discuss this in detail later.
The second peak correlates with recurrence after local therapy or metastatic disease. It is treated with local or systemic therapy.
The third peak correlates with the castrate-resistant prostate cancer, that is the disease which has progressed on hormonal therapy. It is usually treated with chemotherapy but other agents may also be used.
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