Advanced prostatic carcinoma. Early versus late endocrine therapy.
Since the landmark observations of Huggins and Hodges in 1941, androgen deprivation has been the mainstay of treatment for advanced-stage prostate cancer. Although early, poorly controlled studies suggested enhanced survival with hormonal therapy, this view fell into disfavor as a result of the observations of the first and second VACURG studies. Recently, there has been a proliferation of experimental and clinical data supporting early androgen deprivation, including a reanalysis of the VACURG data, which suggests a survival advantage for younger patients with stage D disease and high-grade tumors who undergo androgen-ablative therapy at the time of diagnosis. The risk-benefit analysis presented in this review is strongly supportive of early hormonal therapy. Finally, long-term survival of patients with metastatic prostate cancer will require the development of novel treatment strategies effective against androgen-resistant tumor cells and their use in concert with early androgen deprivation.
Kozlowski
J M
JM
GU Oncology Program, Northwestern University Medical School, Chicago, Illinois.
Ellis
W J
WJ
Grayhack
J T
JT
D000726:Androgen Antagonists / Q000627:therapeutic use*; D000818:Animals; D004054:Diethylstilbestrol / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009919:Orchiectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D013997:Time Factors
D000726:Androgen Antagonists; D004054:Diethylstilbestrol