Hormone refractory disease

Hormone refractory disease is observed in less than 20% of newly diagnosed cases of advanced prostatic cancer. In the majority of cases, hormone refractory disease appears after a median time of 18 months of endocrine manipulation and is attributed to the selection and/or cloning of pre-existing or de novo appearing hormone-independent or resistant cell lines. There are no generally accepted rules for second-line management. The varying sets of criteria used by different study groups make comparisons of widely different regimens very difficult. Actually, it seems reasonable to consider length of survival as the only objective response criterion. This implies, however, that there should be an unanimous definition about the moment of primary treatment failure. Indeed, the detection of hormonal escape is a gradual event and the relative length of survival time depends on the chosen moment of therapy administration. To date, monitoring of prostate specific antigen (PSA) has become the best and primary tool to document progression of disease. Earlier diagnosis based on a rise in PSA levels in patients that are still asymptomatic with a good performance status, might provide the opportunity to treat patients that could profit from therapy and give a fair chance to the investigated drug to show efficacity and tolerability. In this paper we will discuss the rationale of the current available second-line therapeutic options in relapsed prostatic cancer.