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Treatment of Androgen-Independent Prostate Cancer

Beth Israel Hospital and Harvard Medical School, Division of Hematology/Oncology, Boston, Massachusetts, USA

Correspondence: Glenn J. Bubley, M.D., or Steven P. Balk, M.D., Ph.D., Beth Israel Hospital and Harvard Medical School, Division of Hematology/Oncology, 330 Brookline Avenue, Boston, MA 02215, USA. Telephone: 617-667-5288; Fax: 617-667-3915.

Androgen-ablative therapy for metastatic prostate cancer is effective for 60%-80% of men, but its effects are always finite and the majority of men develop androgen-independent disease within two years. Although current therapies for androgen-independent disease have not been shown to impact on survival, recent clinical and laboratory insights offer hope for effective therapy. For instance, recent data indicate that androgen-independent disease may still be dependent on hormonal stimulation, suggesting that hormonally based therapies may provide continued benefit. Chemotherapy, especially with estramustine and etoposide, seems to be an effective combination for a majority of patients. Treatment with suramin had been hampered by its side effects, but new dosing schedules are effectively circumventing toxicity. Radioisotopes such as strontium 89 have been shown to provide effective palliation for a majority of androgen-independent patients. Overall, these and other emerging efforts may be the foundation for therapies that offer hope for a significant survival benefit.

Key Words. Prostate cancer • Hormonal therapy • Androgen receptor • Chemotherapy

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