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Initial systemic therapy for castration sensitive prostate cancer

Authors
Richard J Lee, MD, PhD
Matthew R Smith, MD, PhD
Section Editors
Nicholas Vogelzang, MD
W Robert Lee, MD, MS, MEd
Jerome P Richie, MD, FACS
Deputy Editor
Michael E Ross, MD

INTRODUCTION

The critical role of androgens in stimulating prostate cancer growth was established in 1941 by Charles Huggins [1,2]. These findings led to the development of androgen deprivation therapy (ADT) as the treatment for patients with advanced prostate cancer.

Although ADT is palliative, it can normalize serum levels of prostate-specific antigen (PSA) in over 90 percent of patients and can produce objective tumor responses in 80 to 90 percent. This antitumor activity can improve quality of life by reducing bone pain as well as the rates of complications (eg, pathologic fracture, spinal cord compression, ureteral obstruction).

The duration of response to ADT for patients with metastatic disease is highly variable, and most prostate cancer patients eventually experience disease progression despite treatment. Patients who have progressed while on ADT are said to have castration resistant disease, although such tumors may remain responsive to additional therapies directed against androgenic stimulation of the prostate cancer.

Docetaxel was subsequently shown to prolong survival in men with castration resistant prostate cancer. Randomized controlled trials have demonstrated that chemohormonal therapy combining docetaxel with ADT offers a clinically meaningful survival advantage for patients with castration sensitive metastatic disease. (See "Chemotherapy in castration-resistant prostate cancer", section on 'Chemotherapy-naive patients' and 'Chemohormonal therapy' below.)

The initial therapy for men with castration sensitive metastatic prostate cancer will be reviewed here. An overview of the treatment of disseminated prostate cancer is presented separately, as are special considerations for patients whose only manifestation of disseminated disease is a rising serum PSA. (See "Overview of the treatment of disseminated prostate cancer" and "Rising serum PSA after treatment for localized prostate cancer: Systemic therapy".)

                                  

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Literature review current through: Mar 2017. | This topic last updated: Feb 16, 2017.
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