Medical therapy of prostate cancer: 1999

Prostate cancer is the most commonly diagnosed male malignancy and the second most common cause of male cancer death in the U.S. The principles of management of newly diagnosed metastatic prostate cancer have changed little in the last 50 years. Medical therapy continues to have no standard role in the management of localized disease. The various hormonal monotherapy approaches targeting androgen deprivation yield comparable results in the treatment of advanced disease. Supplementing an LHRH agonist (but not orchiectomy) with an antiandrogen may improve survival in men with minimal disease, but the economic cost and the risk for significant impairment of quality of life are quite high. The benefit of combined androgen blockade for patients with more extensive disease remains unclear, with support for this approach waning in recent years. New chemotherapeutic agents and combinations of such, as well as agents with entirely new mechanisms of action, recently have shown encouraging results in the treatment of HRPC. Much additional research is needed to improve our armamentarium against this epidemic disease.