Challenges in the Management of Prostate Cancer

Abstract

An estimated 32,000 American men will die of prostate cancer this year. Local prostate cancer may be successfully treated by radical prostatectomy or radiotherapy. Advanced cases may necessitate the use of hormonal ablation with bilateral orchiectomy, an approach that is regarded as the gold standard of therapy but not always the preferred treatment of patients. Oestrogen therapy is an alternative but is associated with side effects, such as hot flushes and gynaecomastia, which frequently lead to treatment cessation. Luteinising hormone-releasing hormone (LHRH) analogues work by initially producing a surge of androgen, followed by a down-regulation in hormone production to effect a medical castration. Various groups have studied the effects of androgen blockade administered as monotherapy and as combination therapy (LHRH analogue plus antiandrogen). The National Cancer Institute intergroup protocol 0036, which is the largest cooperative study to date of patients with advanced prostatic cancer, showed that combination therapy with leuprolide and flutamide offered greater benefit in both time to disease progression and median survival while circumventing tumour flare and its associated symptoms. Thus, combination therapy for total androgen ablation may become the new treatment standard for advanced prostatic cancer, pending further studies in the efficacy and cost-effectiveness of all available treatments.

Expression of Tip60, an androgen receptor coactivator, and its role in prostate cancer development

“…However, despite the high (80%) rate of response to hormone treatment, the median duration of response is less than 3 years (Crawford, 1992). Consequently, nearly all hormonedependent CaP eventually relapse as fatal hormoneindependent disease (hormone refractory, HR), while the molecular basis of this progression still remains unknown.…”

Herbal Extract ofWedelia chinensisAttenuates Androgen Receptor Activity and Orthotopic Growth of Prostate Cancer in Nude Mice

“…Despite the low incidence of prostate cancer in oriental countries, statistics from Taiwan reveal prostate cancer deaths have continued to increase in the past two decades. 5 Androgen ablation therapy remains the most effective means of treating metastatic prostate cancer tumors (2,3). This therapy often induces apoptosis in the majority of prostate cancer cells by blocking testosterone signaling at the androgen receptor (AR) and lowering the expression of AR-regulated genes including prostate-specific antigen (PSA), a serologic biomarker up-regulated by androgens (4,5).…”

Maximum androgen blockade: a case study report

“…There is extensive evidence to suggest that¯are protection should be used in all metastatic prostate cancer patients when beginning LHRHa therapy. 37,38 Case six. Case six is a 62-y-old man, otherwise healthy, who was referred with lower urinary tract symptoms (LUTS) which had increased in severity during the last 6 months.…”