title: Treatment of advanced prostatic cancer.
abstract: Many treatment modalities are available to patients with disseminated adenocarcinoma of the prostate. Although no single therapeutic approach can be advocated for all patients at the present time, delay of endocrine manipulation until the onset of symptoms is the recommended approach because it maintains the most normal lifestyle in these patients. With the onset of symptoms such as bone pain or urinary retention, or perhaps as disease progression becomes apparent, orchiectomy is recommended to patients with increased cardiovascular risks as well as to those patients who are judged irresponsible in taking oral estrogens. A dose of 1 mg of diethylstilbestrol three times daily achieves a castrate level of serum testosterone and may not increase cardiovascular mortality. Because of the relative safety and lack of side effects, GnRH analogues represent an alternative treatment in selected patients, particularly in those who refuse orchiectomy or have an increased risk of developing cardiovascular complications. Hormonal manipulation with androgen deprivation remains the cornerstone of treatment and provides clinical remission in the majority of patients with advanced prostate cancer. The prognosis is poor once tumor has recurred. Several secondary forms of endocrine therapy are available, but it would help to be able to select those patients with hormonally sensitive tumors that would respond favorably to these modalities. Transurethral surgery and radiotherapy are effective in palliating patients with bladder outlet obstruction and bony metastases unresponsive to hormonal therapy. Nonhormonal cytotoxic agents are available, but well-controlled studies are required to determine the value of specific agents, whether used alone or in combination.
mesh_terms: D000315:Adrenalectomy; D000616:Aminoglutethimide / Q000627:therapeutic use; D000726:Androgen Antagonists / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D003534:Cyproterone / Q000031:analogs & derivatives / Q000627:therapeutic use; D017373:Cyproterone Acetate; D004967:Estrogens / Q000627:therapeutic use; D005485:Flutamide / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007654:Ketoconazole / Q000627:therapeutic use; D008297:Male; D008535:Megestrol / Q000031:analogs & derivatives / Q000627:therapeutic use; D019290:Megestrol Acetate; D009919:Orchiectomy; D010906:Pituitary Hormone-Releasing Hormones / Q000627:therapeutic use; D011471:Prostatic Neoplasms / Q000628:therapy*; D013148:Spironolactone / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000726:Androgen Antagonists; D004967:Estrogens; D005938:Glucocorticoids; D010906:Pituitary Hormone-Releasing Hormones; D000616:Aminoglutethimide; D013148:Spironolactone; D017373:Cyproterone Acetate; D005485:Flutamide; D003534:Cyproterone; D008535:Megestrol; D007654:Ketoconazole; D019290:Megestrol Acetate