Therapy for Advanced and Hormone Refractory Cancer of the Prostate

Cancers of the prostate are categorized as follows: 1)hormone-naive (never having previously received hormone manipulation); 2)androgen-dependent (having received hormonal manipulation but a less than continuous application, i.e., intermittent androgen blockade or with an agent that does not produce a castrate testosterone level, i.e., antiandrogen); 3)androgen independent (progressive disease when serum testosterone levels are in the castrate range) but still potentially responsive to other hormone therapy, i.e., second line hormone therapy; 4)hormone-independent or hormone refractory (progressive disease when castrate serum testosterone levels have been documented and one or more further hormonal manipulations have failed). Here in, we present an extensive review of current modalities of therapy for advanced and hormone refractory cancer of the prostate. This revision includes a discussion of how hormone therapy should be delivered, when hormone therapy should be delivered, and appropriate monitoring for response in androgenindependent disease. The chemotherapy and other strategies for hormone refractory prostatic cancer are discussed and we present the guidelines of the National Comprehensive Cancer Network for standard chemotherapy options. A discussion on the state of the art palliative radiotherapy as an alternative or adjunct to chemotherapy is presented. Finally, we present the new areas of research in advanced prostatic cancer, including vaccines, antibodies, gene therapy, anti-angiogenesis therapy, antisense therapy and blocking signal transduction