Medical therapy of prostate cancer

Prostate cancer is now the most commonly diagnosed male malignancy and the second most common cause of male cancer death in the U.S. There is no standard role for medical therapy in the treatment of localized disease, although ongoing trials are investigating possible adjuvant and neoadjuvant roles. Subtotal androgen ablation by surgical or medical means is standard therapy for advanced disease, but such therapy does not exterminate the androgen-independent clone which is hypothesized to develop very early in the course of the disease. The current favored medical therapy for subtotal androgen ablation is the use of a depot formulation of an LHRH agonist accompanied initially by an antiandrogen. Once first-line hormonal therapy has failed, there is little to be gained by any other hormonal therapy, although withdrawal of the hormone(s) might itself be a therapeutic maneuver. Cytotoxic agents presently have no standard role in the management of prostate cancer. Future effective therapies for prostate cancer are being presaged by advances in prostate tumor biology.