| Rank |
Pathway / Axis |
Cancer Cells |
Normal Cells |
TSF |
Primary Effect |
Notes / Interpretation |
| 1 |
Androgen receptor signaling |
↓ AR transcriptional output |
↓ androgen signaling in androgen-responsive tissues |
R-G |
Blocks ligand-driven AR signaling |
Core mechanism and main therapeutic axis. Best supported in prostate cancer. |
| 2 |
Androgen-dependent proliferation and survival |
↓ proliferation, ↓ tumor support programs |
↔ in most non-androgen-dependent tissues |
G |
Cytostatic endocrine suppression |
Effect depends strongly on AR dependence of the tumor. |
| 3 |
Combined androgen blockade |
↓ residual androgen-axis signaling |
Systemic endocrine effects ↑ |
G |
Adds AR blockade to castration or GnRH suppression |
Main approved clinical use is with LHRH analog therapy, not as modern stand-alone intensification. |
| 4 |
AR antagonist to agonist conversion in resistance |
↔ or ↑ AR signaling (context-dependent) |
↔ |
G |
Therapeutic escape |
In resistant or mutant AR contexts, first-generation antiandrogens can lose antagonism or behave as partial agonists. |
| 5 |
MAPK stress signaling |
↔ or mixed (model-dependent) |
↔ |
R-G |
Secondary signaling modulation |
Nestronics lists MEK↑, p-ERK↑, SAPK↑, p-JNK↓ from a combination paper; this is not a robust core bicalutamide mechanism. |
| 6 |
NF-κB inflammatory survival axis |
↓ (model-dependent) |
↔ |
R-G |
May reduce pro-survival signaling in some models |
Support is preclinical and often combination-context rather than a defining monotherapy action. |
| 7 |
MUC1 and migration-related signaling |
↓ migration-associated programs (model-dependent) |
↔ |
G |
Possible anti-migratory effect in selected models |
Low-centrality mechanism; evidence is limited and not broadly clinical. |
| 8 |
Clinical Translation Constraint |
Resistance heterogeneity ↑; efficacy strongest in AR-driven disease |
Hepatic toxicity risk, gynecomastia, anticoagulant interaction |
G |
Limits durability and broad applicability |
Important constraints are AR-mutation or CRPC escape, liver monitoring, CYP3A4 and warfarin interaction risk, and the fact that current standard care often favors newer AR inhibitors. |