title: The treatment challenge of hormone-refractory prostate cancer.
abstract: BACKGROUND
  Both the demographics and treatment of hormone-refractory prostate cancer (HRPC) are changing. Patients are younger and healthier, with fewer comorbidities. The "no treatment until symptoms" approach is disappearing. Chemotherapy is increasingly being utilized.
  
  
  METHODS
  The authors review the steps involved in hormone management before chemotherapy is considered. The roles for chemotherapy in current clinical trials are examined.
  
  
  RESULTS
  Effective hormonal management of the prostate cancer patient incorporates an understanding of the stages of hormone sensitivity and prescribing additional interventions beyond simple castration. Once hormone refractoriness is established, the combination of mitoxantrone and prednisone has become a standard chemotherapeutic approach. New agents such as docetaxel are being tested in phase III trials against mitoxantrone plus prednisone.
  
  
  CONCLUSIONS
  HRPC is now regarded as a chemotherapy-sensitive tumor. The goals of chemotherapy in HRPC are to decrease PSA level and improve quality of life. New agents and combinations are needed to improve survival.
authors.affiliation: Head and Neck Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA. KishJA@moffitt.usf.edu
authors.forename: J A
authors.initials: JA
authors.lastname: Kish
authors.forename: R
authors.initials: R
authors.lastname: Bukkapatnam
authors.forename: F
authors.initials: F
authors.lastname: Palazzo
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D004961:Estramustine / Q000008:administration & dosage; D006801:Humans; D008297:Male; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000378:metabolism
chemical_list: D018931:Antineoplastic Agents, Hormonal; D004961:Estramustine