[Cancer of the prostate. The practical problems posed by hormonal escape]

Hormonal escape is defined as the continuation or progression of the course of prostatic cancer despite suppression of testicular androgens. Although 80% of patients are initially sensitive to the suppression of testicular androgens, 10% of patients die within six months, 50% die within three years and only 10% survive ten years. This phenomenon of hormonal escape reflects the selection of hormone-resistant clones rather than an adaptation of the whole population of tumour cells to the new conditions of androgen deprivation. Although various histological and biochemical elements and even a complex prognostic index can predict the duration of sensitivity to hormone treatment, it is virtually impossible to predict the duration of response of a given patient. The duration of response to hormonal treatment is identical, regardless of the modalities of suppression of testicular androgens. It is not significantly affected by either total androgenic deprivation (suppression of adrenal androgens) nor by the combination of cytotoxic drugs with androgenic treatment. When hormonal escape occurs, changing the modalities of androgenic suppression or escalation of the hormone therapy (increased doses of oestrogens, suppression of adrenal androgens, hypophysectomy) are generally of extremely limited value. The use of cytotoxic chemotherapy, with or without androgenic triggering, has not been shown to be significantly more effective than symptomatic treatment. In the current state of knowledge, cytotoxic chemotherapy should be reserved for patients included in rigorous clinical investigation protocols.