Vía trasera de la síntesis de testosterona (backdoor pathway)

Testosterone is an intracrine hormone that is synthesized from cholesterol, using a cascade of enzymes that is best known of «frontdoor» pathway for production. However, there are at least two alternative adrenal ways for testosterone synthesis also considered «frontdoor» and two «backdoor» pathways that just now are beginning to be recognized with clinical significance. In prostate cancer the presence of testosterone and its by-products is essential, in what is known as the «androgen's hypothesis». Additionally in prostate cancer the remaining amounts of androgens are very important, as well as knowing if the body has some alternate routes to produce the most important androgens, i.e. dihydrotestosterone (DHT). Knowing the «backdoor pathway» and controlling it is fundamental in the current management of prostate cancer. The so-called ultra-castration (or hypercastration) is not the final frontier in the treatment of hormone resistant disease; alternatives related to the androgen receptor as its modification or destruction are in experimentation.