Advanced prostate cancer

Prostate cancer is the most frequently diagnosed neoplasm in men in the United States and the second leading cause of cancer deaths. Traditionally, advanced prostate cancer was used in reference to patients with bony metastases. Changes in the management and detection of adenocarcinoma of the prostate have altered the very definition of what we consider advanced disease. Over 50% of patients newly diagnosed with adenocarcinoma of the prostate present with locally advanced or metastatic lesions. This corresponds to stages T3, N+, or M+. Sixty-eight percent of patients with advanced adenocarcinoma of the prostate will respond to androgen withdrawal. This may come in the form of either orchiectomy, estrogen administration, or luteinizing hormone-releasing hormone (LHRH) agonist administration. Unfortunately, one-half of patients with metastatic adenocarcinoma of the prostate will live less than two years. The mean survival of patients presenting with metastatic disease is 1.8 years. Once patients relapse from hormonal control of advanced prostatic carcinoma, few will respond to cytotoxic chemotherapy. Since the introduction of hormonal therapy by Huggins and Hodges in 1941, multiple forms of androgen manipulation have been proposed. The concept of advanced prostatic carcinoma needs to include not only those patients with Stage D-2 (M+), but also those with D0, D1 (N+), C (T-3), a rising prostate-specific antigen (PSA) after radical prostatectomy, and initial high Gleason grade (9 to 10). These patients are all at significant risk of progression and potential death due to prostate cancer.