Mitchell and Chang have reviewed current controversies in the management of the substantial minority of patients (in developed countries at least) who are diagnosed with locally advanced or metastatic disease.
In summary they state that “[t]he beneficial role of prostatectomy has been affirmed in several studies examining its therapeutic impact in locally advanced, nonmetastatic prostate cancer. Adjuvant therapy with radiation or hormones appears to increase prostate-specific antigen relapse-free survival. Whether prostate-specific antigen relapse-free survival is an appropriate surrogate for overall survival remains unverified. The timing and duration of hormonal therapy continues to be debated. Hormone therapy administered ‘too late’ in the course of metastatic disease portends a shortened survival but possible side effects of androgen ablation must be considered. Several docetaxel-based combination chemotherapies for hormone refractory prostate cancer are being studied, but their efficacy in the neoadjuvant setting thus far has been limited. Progress in the palliation of bony metastases has resulted in a decrease in symptoms and skeletal events.”
Perhaps the most important conclusion that they reach is as follows: “The literature of the last few years universally emphasizes the importance of a multidisciplinary collaboration in prostate cancer.” The “New” Prostate Cancer InfoLink would absolutely agree that such collaboration is critical to the effective management of all patients with non-localized prostate cancer.
Filed under: Uncategorized
