Managing prostate cancer. Part II: Disseminated disease

Each year in the United States, approximately 100,000 men are found to have prostate cancer. Of these, about half show evidence of bony metastases at the time of presentation. Each year, too, some 30,000 American men die of prostate cancer. Conceptually, the treatment of metastatic prostate cancer has changed little in the 50 years since Charles B. Huggins and Clarence V. Hodges discovered the hormone-dependent nature of prostate cancer cells. Still, as the years have passed, several therapeutic options have become available. For the most advanced cases, treatment centers on relief of urinary obstruction and amelioration of the pain of bony metastases, along with vigilance for the potentially disastrous sequelae of acute neurologic change due to spinal fractures. In Part I of this article, which appeared in the April 15 issue of Hospital Practice, we discussed the assessment and management of localized carcinoma of the prostate. In this part, the focus shifts to disseminated disease (Figure 1). We again present two cases representing distinctly different points on the spectrum of disease and discuss how management would proceed in each case. This strategy affords an opportunity to review the various available treatment options, with their advantages and drawbacks.