- Prostate cancer is the most frequent cancer in men in the United States. 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 (LHRH) 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 LHRH agonist alone or an LHRH 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 LHRH 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 castrate-refractory prostate cancer and is considered first-line therapy for these patients. Additional effective agents include cabazitaxel, enzalutamide, and abiraterone.
On completion of the chapter, the reader will be able to:
List the risk factors associated with the development of prostate cancer.
Compare placebo versus finasteride for the prevention of prostate cancer.
Recommend an initial treatment for prostate cancer on the basis of stage, Gleason score, prostate-specific antigen (PSA), patient age, and symptoms.
Select an initial and secondary hormonal manipulation for newly diagnosed advanced prostate cancer.
Understand the role of chemotherapy and immunotherapy in the treatment of metastatic castrate-resistant prostate cancer.
Prostate cancer is the most commonly diagnosed cancer in American men.1 For most men, prostate cancer has an indolent course, and treatment options for early disease include expectant management, surgery, or radiation. With expectant management, patients are monitored for disease progression or development of symptoms. Localized prostate cancer can be cured by surgery or radiation therapy, advanced prostate cancer is not yet curable. Treatment for advanced prostate cancer can provide significant disease palliation for many patients for several years after diagnosis. The endocrine dependence of this tumor is well documented, and hormonal manipulation to decrease circulating androgens remains the basis for the treatment of advanced disease.
Prostate cancer is the most frequent cancer among American men and represents the second leading cause of cancer-related deaths in all males.1 In the United States alone, it is estimated that 238,590 new cases of prostatic carcinoma were ...