The role of systemic cytotoxic therapy for prostate cancer

Prostate cancer is among the most common types of cancer and cause of cancer-related deaths among men in the USA and Europe. Despite improvements in early detection and treatment for localized disease, many patients still present with advanced disease, or attempted curative local therapy fails. Although hormone therapy is successful initially in the vast majority of patients, most develop hormone-refractory prostate cancer (HRPC) after 18-24 months. In the past, the use of chemotherapy in the management of prostate cancer has been limited, but recent evidence of its efficacy in HRPC has prompted further research to determine if it could have a more extensive role in the treatment of this disease. Data from several studies have highlighted the possible beneficial effects of incorporating chemotherapeutic agents in treatment regimens for HRPC, showing evidence of a survival advantage. One of the goals of research now is to determine optimal management strategies for different patient populations with prostate cancer. Preliminary data suggest that further improvements in efficacy might be achieved with multi-agent chemotherapy or by treating patients earlier in the disease process.