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Management of Advanced Prostate Cancer

^a SOMPS, Salpêtrière Hospital, Department of Medical Oncology, Paris, France; ^b Centre Charlebourg, la Garenne-Colombes, France

Correspondence: Gerald Auclerc, M.D., Salpêtrière Hospital, Department of Medical Oncology, 47 Boulevard de l'Hôpital, 75013 Paris, France. Telephone: 33-1-4216-0474; Fax: 33-1-4336-4841.

Most cases of advanced carcinoma of the prostate are hormonosensitive. The use of combined androgen blockade (CAB) seems to improve survival and quality of life, but only when combined with chemical castration by luteinizing-hormone-releasing hormone analog and without the use of steroidal antiandrogens. After CAB, further hormonal treatments remain efficacious, such as antiandrogen withdrawal followed by estrogens, aromatase inhibitors, and hormone-refractory prostate cancer multiple cytotoxic agents. For painful bone lesions, external beam radiotherapy, biphosphonates, and strontium 89 or samarium 153 provide pain relief. The use of new methods for the evaluation of response and quality of life will allow the rapid identification of effective treatments and permit powered phase III trials.

Key Words. Advanced prostate cancer • Hormonal therapy • Hormone resistance • Irradiation • Chemotherapy • Quality-of-life evaluation

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