- Prostate cancer is the most frequent cancer in U.S. men. African American ancestry, family history, and increased age are the primary risk factors for prostate cancer.
- Prostate-specific antigen is a useful marker to detect prostate cancer at early stages, predict outcome for localized disease, define disease-free status, and monitor response to androgen-deprivation therapy or chemotherapy for advanced-stage disease.
- The prognosis for prostate cancer patients depends on the histologic grade, the tumor size, and the disease stage. More than 85% of patients with stage A1 disease but less than 1% of those with stage D2 can be cured.
- Androgen deprivation therapy with a luteinizing hormone–releasing hormone (LH-RH) agonist plus an antiandrogen should be used prior to radiation therapy for patients with locally advanced prostate cancer to improve outcomes over radiation therapy alone.
- Androgen deprivation therapy, with either orchiectomy, an LH-RH agonist alone or an LH-RH agonist plus an antiandrogen (combined hormonal blockade), can be used to provide palliation for patients with advanced (stage D2) prostate cancer. The effects of androgen deprivation seem most pronounced in patients with minimal disease at diagnosis.
- Antiandrogen withdrawal, for patients having progressive disease while receiving combined hormonal blockade with an LH-RH agonist plus an antiandrogen, can provide additional symptomatic relief. Mutations in the androgen receptor have been documented that cause antiandrogen compounds to act like receptor agonists.
- Chemotherapy, with docetaxel and prednisone improves survival in patients with hormone-refractory prostate cancer. Patients with hormone-refractory prostate cancer should be considered for entry into clinical trials investigating new therapies for prostate cancer.
On completion of the chapter, the reader will be able to:
- 1. Describe the incidence and mortality of prostate cancer.
- 2. List the risk factors associated with the development of
- 3. Understand the pathophysiology underlying the clinical
symptoms associated with prostate cancer.
- 4. Compare placebo versus finasteride for the prevention of
- 5. List the agents under investigation for the chemoprevention
of prostate cancer.
- 6. Recommend a prostate cancer screening program for a man
based on his age and risk factors.
- 7. Describe the rationale for expectant management of prostate
- 8. Recommend a treatment for initial treatment of prostate
cancer based on stage, Gleason score, age, and symptoms.
- 9. Compare the efficacy of radiation therapy versus surgical
therapy for the initial management of prostate cancer.
- 10. Describe the role of orchiectomy in the treatment of prostate
- 11. Outline the role of luteinizing hormone-releasing hormone
(LHRH) agonists in the treatment of prostate cancer.
- 12. Contrast the benefits and risks of LHRH single-agent therapy
and combined androgen blockade in the first-line therapy of metastatic
- 13. Understand the role of chemotherapy in the treatment
of metastatic, hormone refractory prostate cancer.
- 14. Describe the toxicities associated with docetaxel therapy
and their management.
- 15. Evaluate the economic impact of the treatment of prostate
Prostate cancer is the most commonly diagnosed cancer in American men.1 For ...