Castration-Resistant Prostate Cancer: Sequencing Oral and Infusion Agents.

PURPOSE OF REVIEW: To update treatment options and considerations for castration-resistant prostate cancer with specific attention to sequencing of agents based on available evidence and treatment rationale. RECENT FINDINGS: The newest research developments over the last several years include multicenter studies that address the sequencing of therapies to improve the treatment of metastatic castration-resistant prostate cancer. Chemotherapy agents, as well as androgen receptor antagonists, are evolving, and there are new tests available to define which patients are more likely to benefit. In addition, there have been some additional trials looking into the safety and efficacy of combination treatment and new therapies. There are multiple factors that should be considered to determine the sequence and/or combinations of therapies for metastatic castration-resistant prostate cancer that can improve quality of life and survival. Promising novel agents in combination with personalized medicine will likely continue to improve treatment of these patients.

Integration of contextual cues into memory depends on "prefrontal" N-methyl-D-aspartate receptors.

Every learning event is embedded in a context, but not always does the context become an integral part of the memory; however, for extinction learning it usually does, resulting in context-specific conditioned responding. The neuronal mechanisms underlying contextual control have been mainly investigated for Pavlovian fear extinction with a focus on hippocampal structures. However, the initial acquisition of novel responses can be subject to contextual control as well, although the neuronal mechanisms are mostly unknown. Here, we tested the hypothesis that contextual control of acquisition depends on glutamatergic transmission underlying executive functions in forebrain areas, e.g. by shifting attention to critical cues. Thus, we antagonized N-methyl-D-aspartate (NMDA) receptors with 2-amino-5-phosphonovaleric acid (AP5) in the pigeon nidopallium caudolaterale, the functional analogue of mammalian prefrontal cortex, during the concomitant acquisition and extinction of conditioned responding to two different stimuli. This paradigm has previously been shown to lead to contextual control over extinguished as well as non-extinguished responding. NMDA receptor blockade resulted in an impairment of extinction learning, but left the acquisition of responses to a novel stimulus unaffected. Critically, when responses were tested in a different context in the retrieval phase, we observed that NMDA receptor blockade led to the abolishment of contextual control over acquisition performance. This result is predicted by a model describing response inclination as the product of associative strength and contextual gain. In this model, learning under AP5 leads to a change in the contextual gain on the learned association, possibly via the modulation of attentional mechanisms.

Context specificity of both acquisition and extinction of a Pavlovian conditioned response.

It is widely held that the extinction of a conditioned response is more context specific than its initial acquisition. One proposed explanation is that context serves to disambiguate the meaning of a stimulus. Using a procedure that equated the learning histories of the contexts, we show that the memory of an appetitive Pavlovian association can be highly context specific despite being unambiguous. This result is inconsistent with predictions of the Rescorla-Wagner model of learning but in line with configural accounts of contextual control of behavior. We propose an explanatory model in which context serves to modulate the gain of associative strength and which expands upon the configural idea of unitary representations of context and conditioned stimuli.

Neurons in the pigeon caudolateral nidopallium differentiate Pavlovian conditioned stimuli but not their associated reward value in a sign-tracking paradigm.

Animals exploit visual information to identify objects, form stimulus-reward associations, and prepare appropriate behavioral responses. The nidopallium caudolaterale (NCL), an associative region of the avian endbrain, contains neurons exhibiting prominent response modulation during presentation of reward-predicting visual stimuli, but it is unclear whether neural activity represents valuation signals, stimulus properties, or sensorimotor contingencies. To test the hypothesis that NCL neurons represent stimulus value, we subjected pigeons to a Pavlovian sign-tracking paradigm in which visual cues predicted rewards differing in magnitude (large vs. small) and delay to presentation (short vs. long). Subjects' strength of conditioned responding to visual cues reliably differentiated between predicted reward types and thus indexed valuation. The majority of NCL neurons discriminated between visual cues, with discriminability peaking shortly after stimulus onset and being maintained at lower levels throughout the stimulus presentation period. However, while some cells' firing rates correlated with reward value, such neurons were not more frequent than expected by chance. Instead, neurons formed discernible clusters which differed in their preferred visual cue. We propose that this activity pattern constitutes a prerequisite for using visual information in more complex situations e.g. requiring value-based choices.

Recording single neurons' action potentials from freely moving pigeons across three stages of learning.

While the subject of learning has attracted immense interest from both behavioral and neural scientists, only relatively few investigators have observed single-neuron activity while animals are acquiring an operantly conditioned response, or when that response is extinguished. But even in these cases, observation periods usually encompass only a single stage of learning, i.e. acquisition or extinction, but not both (exceptions include protocols employing reversal learning; see Bingman et al.(1) for an example). However, acquisition and extinction entail different learning mechanisms and are therefore expected to be accompanied by different types and/or loci of neural plasticity. Accordingly, we developed a behavioral paradigm which institutes three stages of learning in a single behavioral session and which is well suited for the simultaneous recording of single neurons' action potentials. Animals are trained on a single-interval forced choice task which requires mapping each of two possible choice responses to the presentation of different novel visual stimuli (acquisition). After having reached a predefined performance criterion, one of the two choice responses is no longer reinforced (extinction). Following a certain decrement in performance level, correct responses are reinforced again (reacquisition). By using a new set of stimuli in every session, animals can undergo the acquisition-extinction-reacquisition process repeatedly. Because all three stages of learning occur in a single behavioral session, the paradigm is ideal for the simultaneous observation of the spiking output of multiple single neurons. We use pigeons as model systems, but the task can easily be adapted to any other species capable of conditioned discrimination learning.

Suboptimal criterion setting in a perceptual choice task with asymmetric reinforcement.

Performance on psychophysical tasks is influenced by a variety of non-sensory factors, most notably the magnitude or probability of reinforcement following correct responses. When reinforcement probability is unequal for hits and correct rejections, signal detection theory specifies an optimal decision criterion which maximizes the number of reinforcers. We subjected pigeons to a task in which six different stimuli (shades of gray) had to be assigned to one of two categories. Animals were confronted with asymmetric reinforcement schedules in which correct responses to five of the stimuli were reinforced with a probability of 0.5, while correct responses to the remaining stimulus were extinguished. The subjects' resultant choice probabilities clearly deviated from those predicted by a maximization account. More specifically, the magnitude of the choice bias increased with the distance of the to-be-extinguished stimulus to the category boundary, a pattern opposite to that posited by maximization. The present and a previous set of results in which animals performed optimally can be explained by a simple choice mechanism in which a variable decision criterion is constantly updated according to a leaky integration of incomes attained from both response options.

Stimulus-response-outcome coding in the pigeon nidopallium caudolaterale.

A prerequisite for adaptive goal-directed behavior is that animals constantly evaluate action outcomes and relate them to both their antecedent behavior and to stimuli predictive of reward or non-reward. Here, we investigate whether single neurons in the avian nidopallium caudolaterale (NCL), a multimodal associative forebrain structure and a presumed analogue of mammalian prefrontal cortex, represent information useful for goal-directed behavior. We subjected pigeons to a go-nogo task, in which responding to one visual stimulus (S+) was partially reinforced, responding to another stimulus (S-) was punished, and responding to test stimuli from the same physical dimension (spatial frequency) was inconsequential. The birds responded most intensely to S+, and their response rates decreased monotonically as stimuli became progressively dissimilar to S+; thereby, response rates provided a behavioral index of reward expectancy. We found that many NCL neurons' responses were modulated in the stimulus discrimination phase, the outcome phase, or both. A substantial fraction of neurons increased firing for cues predicting non-reward or decreased firing for cues predicting reward. Interestingly, the same neurons also responded when reward was expected but not delivered, and could thus provide a negative reward prediction error or, alternatively, signal negative value. In addition, many cells showed motor-related response modulation. In summary, NCL neurons represent information about the reward value of specific stimuli, instrumental actions as well as action outcomes, and therefore provide signals useful for adaptive behavior in dynamically changing environments.