[Advanced prostate cancer--a therapeutic dilemma?]

The number of approaches available for the management of metastasizing prostatic carcinoma is overwhelming. If due attention is paid to prognostic factors, however, patients can be effectively treated in the urological practice. Once the condition has been diagnosed the first-line treatment carried out should be orchiectomy. Adjuvant drug therapies with such agents as progestogens and estrogens seem to be of little value. Data are not yet available from prospective studies performed to assess the value of complete androgen blockade. In addition, there is so far only experimental evidence that the effect of endocrine therapy is enhanced by an initial adjuvant chemotherapy in untreated prostatic carcinoma, and this should be investigated in randomized clinical trials. In the case of tumor progression estrogens or antiandrogens can be administered to relieve the symptoms; good effects have been achieved especially with estramustine phosphate. Further progression demands chemotherapy, which should be selected with reference to Berry's parameters. There is no agent or combination generally accepted as the chemotherapeutic agent of choice.