Incorporating tumor biology into therapy for prostate cancer

Prostate cancer remains the most common and the second leading cause of cancer death in men. Despite the frequency of the disease, controversies in management continue for all stages. For patients with localized tumors, deciding whether any treatment is indicated and, if so, selecting the appropriate modalities for an individual patient are at issue. For more advanced local tumors, although definitive data showing a survival benefit are lacking, several groups have been using androgen deprivation prior to surgery or radiation therapy in the hopes of improving local control rates. For patients with established metastases, the timing of androgen ablation is still debated, as is the optimal way to integrate treatments aimed at the androgen-independent cell population--the ultimate cause of death from prostatic cancer. In addition, several groups are focusing on methods to try to predict the natural history of the disease in an individual patient, while reserving the final recommendation on treatment based on the biologic behavior in that individual.