Chemotherapy of Cancer of the Prostate. In: Spiers ASD, editor. Chemotherapy and Urological Malignancy. London: Springer; 1982. pp. 80-96. [DOI: 10.1007/978-1-4471-1332-4_7]

Treatment of advanced cancer of the prostate

Advanced cancer of the prostate may be either locally advanced or distant. Staging methods available to define the extent of the disease are relatively imprecise; non-invasive methods rely on tumour markers and radioisotopes; invasive methods range from fine needle aspiration to lymph node dissection. Exact definitions of criteria of response to treatment are essential to evaluate different forms of treatment. Primary treatment of metastatic disease is based on hormone manipulation. Those who either never respond or relapse after primary treatment may show some response to further hormone therapy but usually require the combination of radiotherapy and analgesia to control their symptoms. The response rates to chemotherapy are disappointing.

The stable state is not an objective response in hormone-escaped carcinoma of prostate

In some clinical trials the use of criteria of stable response of hormone-escaped prostate cancer is justified on the ground that it delineates patients with markedly improved survival, similar to that of partial regression patients. Forty-three patients with hormone-escaped prostate cancer were studied in order to identify other factors which might also predict improved survival. Fifteen patients received palliative treatment only, 17 secondary hormone therapy and 11 chemotherapy. Only one objective partial regression was seen. Thirty-seven patients have died of prostatic cancer, 3 have died of other causes and 3 remain alive. The mean initial hormone response was 14.8 months, the mean time from progression to death 11.3 months, and the mean time from symptoms to death 5.9 months. There was no significant correlation between length of initial response and survival following progression (r = 0.25). Six features of progression were reviewed. Patients presenting with one feature of progression had a significantly better mean survival, 14.8 months, compared with 8.2 months when multiple features indicated progression. It is concluded that the stable state is not an objective response in hormone-escaped carcinoma of prostate but a reflection of the patient's natural disease progression and that the mode of presentation may be a significant prognostic indicator.