Current treatment of advanced prostate cancer

Metastatic prostate cancer has been traditionally treated with androgen ablation using surgical orchiectomy or estrogens. The development of long lasting LHRH analogues has replaced these standard treatments in most patients with advanced prostate cancer. Several nonsteroidal antiandrogens are now available that may be used in combination therapy with LHRH analogues. This approach has been demonstrated in several large trials to improve the control of the disease. In spite of these advances, most men will eventually develop hormone resistance. New strategies being investigated include intermittent androgen ablation and combining initial hormonal therapy with chemotherapeutic agents. The management of hormone refractory disease remains a major clinical problem, with few standard chemotherapy agents demonstrating activity. This article reviews the principles of the current management of advanced prostate cancer and introduces some of the newer strategies under investigation.