The Evolutionary Trap of Prostate Cancer: How Hormone Therapy Drives Neuroendocrine Transformation and the Metabolic Strategies to Defeat It
Prostate cancer remains one of the most widely diagnosed malignancies globally. For decades, the therapeutic roadmap has relied on a foundational paradigm: prostate cancer cells are driven by androgens. Consequently, standard care heavily prioritizes Androgen Deprivation Therapy (ADT) and next-generation androgen receptor pathway inhibitors (ARPIs). While these interventions regularly deliver impressive initial declines in tumor volume and prostate-specific antigen (PSA) markers, they inadvertently establish a high-stakes evolutionary battleground within the tumor microenvironment. By aggressively blocking the androgen axis, conventional therapies exert an intense selective pressure on malignant cells. Instead of eradicating the disease, this environment forces the cancer to adapt, mutate, and evolve. The ultimate manifestation of this survival mechanism is Lineage Plasticity, a process where common, highly treatable prostate adenocarcinoma completely changes its cellular identity, tra...