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Secondary hormonal therapy
1Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, USA. dcsmith@umich.edu
Abstract:
Almost all patients with metastatic prostate cancer will eventually develop hormone refractory disease. In general, these patients should be enrolled in a clinical trial designed to develop new therapies for the treatment of this disease. However, for a variety of reasons, some patients will not be candidates for these trials. In this setting, a secondary hormonal therapy is a viable option. Secondary hormonal therapy continues and extends the two basic approaches used in primary hormonal therapy: reduction in circulating androgens and competitive inhibition of androgen receptor binding. This article reviews the basic concepts of secondary hormonal therapy, including maintenance of testicular androgen suppression, the anti-androgen withdrawal syndrome, and the available agents. In addition, it reviews hormonal agents currently in development that act by other mechanisms to inhibit prostate cancer growth.
Insights
For metastatic prostate cancer patients progressing to hormone resistance, secondary hormonal therapy offers treatment options when clinical trials are unsuitable. This approach extends primary therapies by reducing androgens and blocking androgen receptors.
Area of Science:
- Oncology
- Endocrinology
Background:
- Metastatic prostate cancer frequently progresses to hormone-refractory disease.
- Clinical trials are the preferred treatment for these patients.
- Alternative options are needed for patients ineligible for trials.
Purpose of the Study:
- To review secondary hormonal therapy concepts for hormone-refractory prostate cancer.
- To discuss available and investigational hormonal agents.
- To highlight treatment strategies beyond standard clinical trials.
Main Methods:
- Review of existing literature on secondary hormonal therapy.
- Analysis of mechanisms of action for hormonal agents.
- Discussion of clinical approaches including anti-androgen withdrawal.
Main Results:
- Secondary hormonal therapy builds upon primary approaches: androgen suppression and anti-androgen use.
- Key concepts include maintaining testicular androgen suppression and understanding anti-androgen withdrawal syndrome.
- Several hormonal agents are available, with others under development targeting different mechanisms.
Conclusions:
- Secondary hormonal therapy is a viable option for hormone-refractory prostate cancer patients not in clinical trials.
- Understanding established and novel hormonal agents is crucial for patient management.
- Continued research into new hormonal therapies is essential for improving outcomes.