Treatment of hormone-refractory prostate carcinoma

To review the treatment of hormone-refractory prostate cancer (HRPC).

Almost all patients with metastatic prostatic cancer will eventually escape the control of the first-line endocrine therapy, and relapse. This escape occurs in the majority of patients after a median time of 12-18 months, and 1-year median survival is only 50%. Therefore, additional treatments are needed for men who have disease progression in the presence of castrate levels of serum testosterone. SECOND-LINE TREATMENT: Available second-line therapeutic modalities in relapsed prostatic cancer include endocrine manipulations, chemotherapy, combined endocrine and cytotoxic therapy, and new drugs like suramin. Despite relieving symptoms in some patients, these treatments have a limited capacity to prolong survival. Moreover, potential toxicity of these therapeutic regimens must also be taken into account in order to maintain quality of life. Finally, other palliative adjunctive treatments like analgesic support, radiation therapy for painful bone metastasis (either external beam or isotopic radiotherapy), or locoregional procedures for symptomatic primary tumors (transurethral resection, urinary diversion) have a central role in the therapeutic strategy.