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Related Experiment Videos

Hormone-refractory (D3) prostate cancer: refining the concept

H I Scher1, G Steineck, W K Kelly

  • 1Department of Medicine, Karolinska Hospital, Stockholm, Sweden.

Urology
|August 1, 1995
PubMed
Summary

Hormone-refractory prostate cancer classification needs refinement. A new system based on hormonal sensitivity is proposed to better guide treatment and improve outcomes for patients with advanced prostate cancer.

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Area of Science:

  • Oncology
  • Urology
  • Pharmacology

Background:

  • Hormone-refractory prostate cancer (HRPC) exhibits varied responses to second-line therapies like corticosteroids and antiandrogen withdrawal.
  • Current classifications lack objective criteria, leading to heterogeneity in clinical trial patient populations.

Purpose of the Study:

  • To develop a schema for classifying patients based on hormonal sensitivity.
  • To assess differences in entry criteria and outcomes for clinical protocols involving hydrocortisone in HRPC.

Main Methods:

  • Systematic retrieval of published clinical trials from Medline involving glucocorticoids for patients progressing after primary hormone therapy.
  • Analysis of trials using hydrocortisone alone or in combination with other agents (aminoglutethimide, suramin), dexamethasone, or prednisone.

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Main Results:

  • Definitions of refractory disease varied widely, lacking objective criteria across trials.
  • Inconsistent reporting on hormonal therapy details and patient responses was noted.
  • Few trials controlled for the 'flutamide withdrawal syndrome' impact on outcomes.

Conclusions:

  • The term 'hormone-refractory' encompasses a spectrum of prostate cancer diseases.
  • A proposed classification based on hormonal sensitivity is needed, as androgen-independent progression doesn't always imply refractoriness to all hormonal manipulations.
  • Future trials require detailed reporting of hormonal therapies used in hormonally relapsed patients.