Prostate cancer: management of advanced disease.

Advanced prostate cancer is an incurable disease. Treatment objective is palliation only. The major observation is that prostate cancer is a hormone-sensitive tumour. Huggins and Hodges [1] were the first to demonstrate that castration and estrogen injection had therapeutic activity in men with metastatic prostate cancer. The most frequent metastatic sites in prostate cancer are bone (85%), lymph nodes and further visceral metastases (liver, central nervous system, lungs) (45%) [2]. However, consequences of widespread metastases are important: bone pain, nervous compression and haematological and metabolic consequences. All these conditions must be taken into account in order to select the best treatment options leading to a better quality of life for the patient. This chapter focuses on the practical management of patients with advanced disease; treatment evaluation criteria and new therapeutic approaches will be developed in another section of this educational program.