PTU - Polskie Towarzystwo Urologiczne
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Treatment approaches in patients with hormone resistant prostate cancer
Article published in Urologia Polska 2007/60/2.


Theo M. de Reijke 1, Jean J.M.C.H. de la Rosette 1, Cora N. Sternberg 2
1 Department Of Urology Academic Medical Center, Amsterdam
2 Department of Medical Oncology San Camillo And Forlanini Hospitals, Rome


stercz, rak stercza, hormonooporność, chemioterapia, leczenie celowane


Patients with locally advanced or metastatic prostate cancer are being treated with different forms of androgen deprivation therapy. The median time progression of this treatment approach ranges between 14 and 30 months. Following biochemical or objective progression the prostate cancer cells can still be androgen dependent for some time. The different treatment approaches in this disease stage are being described, including the working mechanism and possible application as second line treatment. Inevitably, however, the patient will progress to a hormone refractory prostate cancer stage. Recently, for the first time it was reported that docetaxel-based chemotherapy resulted in a modest survival benefit of approximately 2 months in patients with hormone refractory prostate cancer. The question is at this moment when to start this palliative chemotherapy and in which patients. Clearly, an improvement of these survival rates is necessary and several other approaches have been or are being investigated in patients with hormone refractory prostate cancer. The current stage of these treatment modalities are being discussed and put into clinical perspective. The great challenge will be to select these treatment modalities from the abundance of new agents that are in the pipeline of the pharmaceutical companies. Which of these targeted therapies have the biggest potential to be active as mono- or combination therapy in patients with prostate cancer? The goal of the treatment using the new treatment modalities will be to convert prostate cancer from a proliferative into a chronic disease. It is clear that selection of patients, using e. g. nomograms, genomics/proteomics, and side effect profile will then be very important. It is obvious that most of these new treatments will be tested in patients with hormone refractory prostate cancer, but once there is proven activity an earlier start of the treatment should be investigated. The setup of clinical trials with other endpoints (not survival) should be discussed in order to speed up the introduction of these new treatment modalities.


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Theo M. de Reijke
Department of Urology
Academic Medical Center
Meibergdreef 9
tel. +31 20 5666004