Management of androgen-independent prostate cancer.

BACKGROUND Although androgen withdrawal can control prostate cancer for long periods in many patients, controversy exists regarding management when the tumor becomes androgen independent. Several options are now available. METHODS A review of the pertinent literature of the last 20 years was conducted to provide guidance in defining and managing hormone-refractory prostate cancer. RESULTS Stage D prostate cancer can be subclassified to correlate tumor biology with disease stage. Secondary hormone manipulations may induce responses in patients after failure of initial androgen suppression, and chemotherapy with docetaxel has prolonged survival in patients with androgen-independent prostate cancer (AIPC). The weight of evidence supports the maintenance of castrate levels of testosterone in metastatic AIPC. Bisphosphonates decrease skeletal complications. CONCLUSIONS Secondary hormone therapy, chemotherapy, and bisphosphonate therapy may provide benefits for selected patients. Correlation of disease stage with biologic characteristics of the tumor and host facilitates proper choices of interventions. Docetaxel-based chemotherapy regimens should be considered for first-line treatment of patients with progressive metastatic AIPC.