Androgen receptor upregulation mediates radioresistance after ionizing radiation

Clinical trials have established the benefit of androgen deprivation therapy (ADT) combined with radiotherapy (RT) in prostate cancer. ADT sensitizes prostate cancer to RT-induced death at least in part through inhibition of DNA repair machinery, but for unknown reasons adjuvant ADT provides further survival benefits. Here we show that androgen receptor (AR) expression and activity are durably upregulated following RT in multiple human prostate cancer models in vitro and in vivo. Moreover, the degree of AR upregulation correlates with survival in vitro and time to tumor progression in animal models. We also provide evidence of AR pathway upregulation, measured by a rise in serum levels of AR-regulated hK2 protein, in nearly 20 percent of patients after RT. Furthermore, these men were three fold more likely to experience subsequent biochemical failure. Collectively, these data demonstrate that RT can upregulate AR signaling post-therapy to an extent that negatively impacts disease progression and/or survival.