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Anti-androgens and other hormonal therapies for prostate cancer
1Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Abstract:
Many men who show evidence of a progression of prostate cancer by rising prostate-specific antigen (PSA) or other symptoms are treated with anti-androgens. Anti-androgen withdrawal represents the first line of treatment after failure of hormonal manipulation. Flutamide is an approved anti-androgen that has been incorporated in many of the combined androgen blockade studies. Bicalutamide is also a nonsteroidal anti-androgen that offers the advantages of reduced dosage amounts and reduction in side effects. Additionally, there are a variety of therapeutic agents that can suppress adrenal secretion of androgens. The most promising of these agents include aminoglutethamide, ketoconazole, and corticosteroids, with an expected response rate of 10% to 15%. Studies have shown that some patients may respond to an anti-estrogen such as tamoxifen. There are a variety of therapeutic treatment options available for patients with hormone refractory prostate cancer. However, quality-of-life issues are becoming increasingly important and should be incorporated into clinical trial endpoints.
Insights
For men with advanced prostate cancer, anti-androgen withdrawal is a key treatment. Other options include adrenal androgen suppressors and anti-estrogens, with quality of life being crucial.
Area of Science:
- Oncology
- Urology
Background:
- Prostate cancer progression is often monitored by rising prostate-specific antigen (PSA).
- Hormonal manipulation is a common treatment strategy for advanced prostate cancer.
Purpose of the Study:
- To review therapeutic options for hormone-refractory prostate cancer.
- To highlight the importance of quality-of-life in treatment decisions.
Main Methods:
- Review of existing literature on prostate cancer treatments.
- Analysis of therapeutic agents including anti-androgens, adrenal androgen suppressors, and anti-estrogens.
Main Results:
- Anti-androgen withdrawal is a primary treatment after hormonal therapy failure.
- Agents like aminoglutethamide, ketoconazole, and corticosteroids show a 10-15% response rate.
- Tamoxifen may benefit some patients.
Conclusions:
- Multiple treatment options exist for hormone-refractory prostate cancer.
- Quality-of-life considerations are increasingly vital and should be integrated into clinical trial endpoints.