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There are few problems more frustrating and depressing to oncologists and cancer patients aliκe than anti-cancer have treatment resistance. It comes in two varieties: primary and acquired. More and more cancers become responsive to newly developed therapies that are successful in inducing responses in cancers previously considered intrinsically resistant, and the emphasis gradually moves on more and more problematic acquired types of resistance. Acquired resistance may arise through many types of mechanisms. One of them is a constitutive activation of NF-κB, which has been described in a great number of solid tumours and this activation appears to support cancer cell survival and to reduce the sensitivity against chemotherapeutic drugs. Additionally, some anticancer therapies induce this transcription factor themselves and through this mechanism lower their own efficiency. In some cases, a first cycle of an anti-cancer treatment may select resistant population of tumour cells that subsequently leads to recurrence of disease and to the failure of treatment. This may be particularly true for tumours that are composed of a heterogeneous population of cells, which is exactly the case of prostate tumours. Tumour progression needs a positive and reciprocal feedbacκ between cancer associated fibroblasts (CAFs) and cancer cells. Cancer cells induce and maintain the fibroblasts activated phenotype (activated transcription of certain genes), which produce a series of growth factors and cytoκines that sustain tumour progression by promoting extracellular matrix (ECM) remodelling, cell proliferation, angiogenesis and epithelialmesenchymal transition (EMT). A thorough understanding of chemoresistance pathways and how they interact would facilitate two important outcomes. Firstly, identifying patients who will not benefit from chemotherapy prior to their exposure will avoid unnecessary toxicity and allow them to move on to alternative treatment options. Secondly, targets for further drug development may also arise. [ABSTRACT FROM AUTHOR]

The role of the urologist in the treatment of prostate cancer (PC) has been always crucial. Obviously working in close cooperation with physicians of other specialties, the urologist has always been managing the treatment. In certain stages of the disease radiotherapists played and plays important role. However, with the introduction of chemotherapy in prostate cancer treatment (castration-resistant stage) engagement of the clinical oncologists became more important. A locally advanced and metastatic PC requires care from the perspective local management of the disease (urination, upper urinary tract patency), symptoms (i.a. pain control), treatment of complications (urinary tract infections, cystolithiasis, etc.), and oncological treatment of the underlying disease. During the initial stages, oncological treatment focuses on hormonal therapy, which as a standard is prescribed by the urologist. Until recently only few treatment options (such as estramustine phosphate and β-irradiators) were available for patients with castration-resistant prostate cancer (CRPC); and this treatment was still managed by the urologist. The engagement of a clinical oncologist became more relevant with the introduction of mitox-antrone and, in particular, docetaxel. Second line CRPC therapy, cytostatic agent cabazitaxel, is also in the hands of the oncologist. However, recently have come and keep coming into clinical practice new treatment options (radium-223 chloride, abiraterone acetate, denosumab, enza-lutamide, sipuleucel-T) that need not to be for technical reasons administered by the oncologist, so therapy can be returned to the hands of the urologist. For this, though, the urologist must be highly knowledgeable and specialized in this specific treatment segment. Healthcare payers constitute another important factor in organizing of care for patients with CRCP. Logically, healthcare payers wish to control the new and expensive treatment modalities entering into the clinical practice. And of course, it is easier to control 13 CCCs (Comprehensive Cancer Centers) than over 600 urologists not stratified from the perspective of control of indication and administration of new expensive drugs. The urologist should continue to play the key role in care for patients with CRCP. It is the urologist who can monitor the patient and manage the therapy in a comprehensive manner; introducing of new mainly oral treatment options into clinical practice also manage the patient in terms of oncological treatment. The patient care although coordinated by the urologist will, of course, depend on cooperation with other specialists, best within the multi-disciplinary teams. For this, however, urologist must be highly educated and specialized in this specific treatment segment. The above concept is supported by recently approved and certified oncourology training course, currently under way. Health care payers will be required to set up a model enabling to centralize and thus to effectively control new CRPC treatment modalities with high cost. [ABSTRACT FROM AUTHOR]