The prostate gland is made of several types of cells:
1. Basal cells: Small in number. Androgen-independent. Do not express androgen receptors. Stem cells of the prostate gland are part of this component of basal cells and give rise to the second type of prostate cells called transitional cells.
2. Transitional cells: Androgen responsive, pluripotent cells that can generate basal cells, luminal cells and possibly neuroendocrine cells.
3. Glandular luminal cells: Androgen-dependent, express androgen receptors, secretory cells that form the largest component of prostate cells. These are the cells that secrete PSA and PAP.
As you can see a normal prostate is mostly made of androgen-dependent cells and androgens regulate the proliferation and death of such cells. Because of the presence of androgen-independent cells in a normal prostate gland, androgen deprivation is not considered curative. On the other hand if applied early enough before the majority of the tumor cells become androgen-independent through mutations or dedifferentiation, this therapy can elicit extended remissions.
The outcome of androgen suppression studies report conflicting results. Some men fail therapy faster than others. Men die when their cancers are vastly disseminated and therapy fails. I believe the reason for that depends on the ratio of androgen-independent to androgen-dependent cells of the tumor volume present at the time the therapy is applied. These results confuse the issue and dilute the value of early versus delayed application of hormonal suppression. There is considerable evidence for early application of androgen suppression, but the evidence is always confounded as mentioned above. The facts are simple. The lowest the disease progression to androgen-independence when hormonal suppression is applied the longer the remission obtained.
I have been living with prostate cancer since 1992. The views or opinions expressed here are my own and are not endorsed nor supported by any agency or institution. Ask your physician for medical advice.
DX at age 58. RP; Orchiectomy; GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall; Stage T4; Last PSA July, 0'11: <0.1 www.pcainaz.org