Background: Prostate carcinoma is the second leading cause of cancer-related death in men in the United States. In nearly all of these men, cancer progressed despite initial treatment with androgen ablation therapy. Managing hormone-refractory prostate carcinoma remains a difficult challenge for the clinician. In the past, cytotoxic chemotherapy was considered inactive, but recent advances have altered this view significantly.
Methods: A MEDLINE review of recent studies of chemotherapy in hormone-refractory prostate carcinoma was performed.
Results: Benefit of treatment may now be measured by prostate specific antigen as a marker of antitumor activity, quality of life and pain scores, and traditional objective measures of response. The antiandrogen withdrawal syndrome and secondary hormonal therapies are important treatment options that usually precede chemotherapy. New drug combinations are demonstrating promising levels of efficacy and proven palliative ability. Two large randomized trials have shown that mitoxantrone in combination with steroids is more effective in improving pain and quality of life than steroids alone. In several Phase II studies, estramustine combinations with vinblastine, etoposide, paclitaxel, or docetaxel produced significant responses in over 50% of patients. Future research will define optimal chemotherapy combinations and test new agents. In addition, systemic chemotherapy is being investigated in earlier stages of prostate carcinoma at high risk for progression.
Conclusions: Cytotoxic chemotherapy has demonstrated clear activity and palliative benefit in patients with hormone-refractory prostate carcinoma. Its role in managing advanced prostate carcinoma patients is growing but remains an area of active investigation.