New treatment strategies in the management of hormone refractory prostate cancer (HRPC): only chemotherapy?

Prostate cancer progression to androgen ablation refractory stage D3 corresponds to cancer cell escape from androgen withdrawal-induced apoptosis. In this development, enhancement of growth factor stimulation has an essential role in the upregulation of survival signals and constitutive proliferation [1]. The mainstay of treatment for metastatic prostate cancer is androgen deprivation. Unfortunately, most of men become resistant to hormonal manipulation, developing what is defined as hormone-refractory prostate cancer (HRPC). A decade ago, most clinicians were reluctant to refer these patients for chemotherapy, which was considered to be ineffective and associated with unacceptable toxicity. A review of 26 chemotherapy-based trials revealed an overall response rate of 8.7% with a median survival ranging from 6 to 10 mo [2]. For this reason, it was established that a median expected survival for patients with HRPC is 10 mo. Therefore, novel therapeutic strategies that target the molecular basis of androgen resistance were required. The aim of this editorial is to underline two possible strategies: the first, specifically targeted to the role of the neuroendocrine (NE) system in hormone-refractory stage development, and the second, chemotherapy, not target specific and only cytotoxic.