Novel approaches to treat asymptomatic, hormone-naive patients with rising prostate-specific antigen after primary treatment for prostate cancer.
Biochemical-only recurrent prostate cancer presents the ideal setting for assessing novel agents or approaches for prostate cancer treatment. There is no clear evidence that delay in initiation of more definitive androgen-deprivation therapy is harmful, and a simple blood test--the prostate-specific antigen (PSA) level--is readily available to screen for potential antineoplastic activity. Current novel approaches include vaccines, cyclooxygenase-2 (COX-2) inhibitors, selective apoptotic antineoplastic drugs, endothelin-A receptor antagonists, chemotherapy, vitamin D, and peroxisome proliferator-activated receptor-gamma agonists. In this screening process, certain therapies have emerged as delaying PSA progression or decelerating PSA velocity. These therapies, such as the COX-2 inhibitors, will need to proceed to phase 3 trials to answer the more important question of whether this change in PSA dynamics translates into improved survival. Patients enrolling in these trials need to be clearly informed of the limited expectations of these novel exploratory approaches.
Dawson
Nancy A
NA
Genitourinary Oncology Program, Greenebaum Cancer Institute, University of Maryland, Baltimore, Maryland 21201, USA.
Slovin
Susan F
SF
D000230:Adenocarcinoma / Q000097:blood / Q000188:drug therapy / Q000628:therapy*; D000728:Androgens; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000951:Antigens, Neoplasm / Q000276:immunology / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000145:classification / Q000627:therapeutic use; D019496:Cancer Vaccines / Q000276:immunology / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D016207:Cytokines / Q000235:genetics; D065130:Endothelin A Receptor Antagonists; D015316:Genetic Therapy; D006801:Humans; D016233:Immunotherapy, Active; D007527:Isoenzymes / Q000037:antagonists & inhibitors; D008297:Male; D008565:Membrane Proteins; D009363:Neoplasm Proteins / Q000097:blood*; D009376:Neoplasms, Hormone-Dependent / Q000097:blood / Q000188:drug therapy / Q000628:therapy*; D016376:Oligonucleotides, Antisense / Q000627:therapeutic use; D011451:Prostaglandin-Endoperoxide Synthases; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy / Q000628:therapy*; D018160:Receptors, Cytoplasmic and Nuclear / Q000037:antagonists & inhibitors; D017479:Receptors, Platelet-Derived Growth Factor / Q000037:antagonists & inhibitors; D016879:Salvage Therapy; D014157:Transcription Factors / Q000037:antagonists & inhibitors; D014807:Vitamin D / Q000627:therapeutic use
D000728:Androgens; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000951:Antigens, Neoplasm; D000970:Antineoplastic Agents; D019496:Cancer Vaccines; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D016207:Cytokines; D065130:Endothelin A Receptor Antagonists; D007527:Isoenzymes; D008565:Membrane Proteins; D009363:Neoplasm Proteins; D016376:Oligonucleotides, Antisense; D018160:Receptors, Cytoplasmic and Nuclear; D014157:Transcription Factors; D014807:Vitamin D; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases; D017479:Receptors, Platelet-Derived Growth Factor; D017430:Prostate-Specific Antigen