The patient, disease status, and treatment options for prostate cancer: Stages D1 and D2

Abstract

The treatment of choice for disseminated prostate cancer remains endocrine manipulation, either bilateral orchiectomy or exogenous estrogens. The recommended dose of diethylstilbestrol is 1 mg tid. Unanswered questions include: When should endocrine manipulation be instituted for the patient with advanced prostatic cancer? At the time of diagnosis, when clinical symptoms occur, or not at all? With few exceptions those patients relapsing after initial endocrine manipulation do not respond to successive attempts at further endocrine therapy. Much of the confusion in this regard relates to the variable response criteria used, more often subjective than objective. Since the polyclonal theory of prostatic cancer is attractive, its logical extension is the evaluation of combinations of treatments including both endocrine manipulation and cytotoxic agents. Because the currently available antiandrogens and luteinizing hormone-releasing hormone agonists have mechanisms of action different from conventional estrogens or bilateral orchiectomy, they too may have a role in the multimodal treatment of advanced prostatic cancer. Therapy for stage D1 prostatic cancer implies that information is available either from pelvic lymphadenectomy or from fine-needle aspiration cytology related to abnormal findings on CT scanning, lymphangiography, or excretory urography. Some evidence exists supporting the case of potential cure by radical prostatectomy when pelvic nodal involvement is minimal. Other options include standard external beam irradiation therapy, endocrine therapy with transurethral prostatic resection, and finally, observation until distant metastases occur. Because of the increased risk of distant metastases in patients with stage D1 prostatic cancer, adjuvant chemotherapy programs are rational with clinical trials now in progress.

Pretreatment Serum Level of Testosterone as a Prognostic Factor in Japanese Men with Hormonally Treated Stage D2 Prostate Cancer.

“…About 70-80% of prostate cancer patients initially respond to endocrine therapy, but more than half of them gradually develop resistance [23]. Once the disease progresses during endocrine therapy, the mean survival is only approximately 6-12 months [24][25][26] . If it were possible to identify those patients whose tumor cells are primarily androgen-insensitive, an alternative treatment might be initiated.…”

The isolation and identification of apolipoprotein C-I in hormone-refractory prostate cancer using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry

“…Prostate cancer is initially androgen-dependent, but after androgen deprivation it often relapses to an androgen-independent state. Once the disease has progressed to this stage during hormone therapy, the mean survival is approximately 6-12 months [2]. If the cancer does not acquire androgen independence, patient survival and quality of life would likely improve dramatically.…”

Megestrol Acetate in Relapsed Carcinoma of Prostate

“…It has been reported that 80% of patients with prostatic carcinoma have hormonally responsive tumours (Bailar and Byar, 1970;Byar, 1973;Altwein, 1982;Schmidt, 1983). If untreated, patients with advanced metastatic disease have a poor prognosis, 69% dying within 18 months (Nesbit and Baum, 1950), and even when treated, relapse commonly occurs within 2 years (Resnick and Grayhack, 1978) with a mean survival of 1.8 years (Schoonees etal., 1972;Klein, 1979) and a 50% mortality rate within 6 months (Johnson et al, 1977;Paulson, 1984).…”