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Selecting a secondary treatment.

Nancy B Davis1, Ashesh B Jani, Nicholas J Vogelzang

  • 1Department of Medicine, Section of Hematology/Oncology, The University of Chicago Medical Center, 5841 South Maryland Avenue, MC2115, Chicago, IL 60637, USA.

The Urologic Clinics of North America
|May 9, 2003
PubMed
Summary
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Early hormonal therapy may extend life in prostate cancer, but large trials are lacking for surgically treated patients or those with PSA-only relapse. Participation in clinical trials is encouraged, reserving hormone therapy for later use.

Area of Science:

  • Oncology
  • Urology
  • Endocrinology

Background:

  • Hormonal therapy is a cornerstone in managing advanced prostate cancer, with evidence suggesting survival benefits.
  • Optimal timing and use of hormonal therapy in specific patient groups, such as those with PSA-only relapse after surgery, remain areas of active investigation.
  • The lack of large-scale trials necessitates careful consideration of treatment strategies in these populations.

Purpose of the Study:

  • To review the current evidence and clinical considerations for early hormonal therapy in prostate cancer, particularly in cases of PSA-only relapse.
  • To discuss the evolving landscape of novel therapeutic agents and the importance of clinical trials in this setting.
  • To outline the established treatment algorithm following the failure of primary hormonal therapy.

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Main Methods:

  • Review of existing literature and clinical trial data on hormonal therapy in prostate cancer.
  • Analysis of treatment strategies for PSA-only relapse and progression after initial hormonal therapy.
  • Discussion of emerging agents and the role of clinical trial participation.

Main Results:

  • Compelling evidence supports hormonal therapy's life-prolonging effects in many prostate cancer stages.
  • Large-scale trial data are absent for surgically treated patients and those with PSA-only relapse, leading to varied clinical practice.
  • Novel agents are under investigation for PSA-only relapse, with trials offering potential benefits.

Conclusions:

  • Early hormonal therapy is often used in PSA-only relapse despite limited large-scale trial data.
  • Patient and physician participation in clinical trials for novel agents is encouraged.
  • Established algorithms exist for managing hormone-refractory prostate cancer, but clinical trials remain crucial as none of these interventions are definitively proven to prolong life.