Female urology

Abstract

with serial PSA monitoring. As this report indicates, the therapy is often prompted by a "chicken switch" reaction. Until data is available, and it is unlikely that it will be in the foreseeable future, careful evaluation of prognostic variables as the authors describe, provide the therapist with at least a logical approach to triggering the switch to androgen deprivation. Pretreatment of Gleason score and PSA and post-treatment progression indicators as PSA level and doubling time currently provide the trigger for the delivery of androgen deprivation to those for whom it will benefit most and withhold it from those who are at sufficiently low risk that the morbidity consequence to the therapy equals or outweighs the benefits that androgen therapy could deliver. Clinical trials will provide the most useful and unbiased information. Some of the current Phase III trials addressing the issue of PSA recurrence are continuous vs intermittent androgen deprivation after irradiation (JPR7-NCI, Canada); androgen deprivation and immediate vs delayed chemotherapy (RTOG, P0014), androgen deprivation ± thalidomide (NCI-00-C0080) and for patients with a rising PSA after androgen deprivation but without evidence of metastatic disease, a trial comparing second line hormone therapy (ketoconazol + hydrocortisone) to chemotherapy (docetaxel and estramustine-ECOG 1899). Other agents are being investigated to address the rising PSA; i.e. Provenge, Atrasantin (endothelin-A inhibitor), Avastin (angrogenesis inhibitor).