Patient Selection for Therapy in Prostate Cancer

Abstract

The two major challenges in prostate cancer today are biochemical failure and hormone-refractory disease. Biochemical failure, manifested by a rising prostate-specific antigen (PSA) level following failure of local therapy, is the most common presentation of advanced prostate cancer. Hormonal therapy can produce dramatic but short-lived response rates in metastatic hormone-sensitive prostate cancer, while chemotherapy possesses the ability to induce significant response rates in refractory disease. Clinicians agree that patients with symptomatic advanced prostate cancer should receive immediate androgen ablation therapy; however, there is debate regarding treatment for asymptomatic patients with advanced disease. While there is no clear evidence to support the widespread use of aggressive interventions such as hormonal therapy with or without chemotherapy in men with biochemical failure, there are a number of studies indicating that early hormonal therapy may prolong the time to disease progression and survival for some patients, with this benefit being more pronounced in men with less tumor burden. Numerous questions remain for patients with advanced prostate cancer regarding optimal therapy, and until these questions are answered, the use of early hormonal therapy with or without chemotherapy for the management of locally advanced and metastatic disease is warranted.