Selecting a secondary treatment.
There is compelling evidence that early hormonal therapy prolongs life in many stages of prostate cancer. Large-scale trials to answer this question have not yet been conducted in surgically treated patients or in patients with PSA-only relapse. Thus, many physicians and patients use early hormone therapy in PSA-only relapse. Many unique new agents are being tested in this population and may offer benefits. Patients and physicians are encouraged to participate in such trials, with hormone therapy reserved for subsequent use. Following failure of primary hormone therapy, a standard algorithm of care exists: antiandrogen withdrawal, use of alternative or first-line anti-androgens. ketoconazole. and chemotherapy. At each interval, clinical trials should be offered since none of these maneuvers are proven to prolong life.
Davis
Nancy B
NB
Department of Medicine, Section of Hematology/Oncology, The University of Chicago Medical Center, 5841 South Maryland Avenue, MC2115, Chicago, IL 60637, USA.
Jani
Ashesh B
AB
Vogelzang
Nicholas J
NJ
D000726:Androgen Antagonists / Q000627:therapeutic use; D001918:Brachytherapy; D005938:Glucocorticoids / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D008297:Male; D009919:Orchiectomy; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000628:therapy*; D018714:Radiotherapy, Adjuvant; D017211:Treatment Failure
D000726:Androgen Antagonists; D005938:Glucocorticoids; D007987:Gonadotropin-Releasing Hormone