UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Secondary endocrine therapies for castration resistant prostate cancer

Author
Nancy A Dawson, MD
Section Editors
Nicholas Vogelzang, MD
W Robert Lee, MD, MS, MEd
Jerome P Richie, MD, FACS
Deputy Editor
Michael E Ross, MD

INTRODUCTION

Androgen deprivation therapy (ADT) is generally the initial treatment for men with advanced prostate cancer, either alone or in combination with chemotherapy. Standard approaches to ADT include orchiectomy, a gonadotropin releasing hormone (GnRH) agonist, or a combination of a GnRH agonist plus an antiandrogen (combined androgen blockade). Despite initial response rates of 80 to 90 percent, nearly all men eventually develop castration-resistant disease. Clinical trials have shown that a number of contemporary systemic therapies can significantly increase overall survival as treatment for castration-resistant prostate cancer in men with castration-resistant disease (table 1).

Several alternative endocrine approaches (other antiandrogens, antiandrogen withdrawal, ketoconazole, glucocorticoids, megestrol acetate, estrogens) have not been demonstrated to improve survival. However, these approaches may induce clinical responses or stable disease. Secondary endocrine therapies are often used sequentially and may be useful in postponing interventions such as chemotherapy with more severe toxicity or when no other effective options are available. These approaches are discussed in this topic.

An overview of the management of advanced prostate cancer is presented separately. (See "Overview of the treatment of disseminated prostate cancer".)

CONTINUATION OF ADT

Androgen deprivation therapy (ADT) is generally continued in conjunction with secondary therapies after progression on the initial ADT regimen [1,2]. Androgenic steroids are growth factors for prostate cancer [3]. When disease progresses, discontinuation of gonadotropin releasing hormone (GnRH) agonist therapy can result in an increase in serum testosterone and thus contribute to progressive disease.

There are no randomized trials that directly address the utility of continued ADT in men with castration-resistant prostate cancer. However, a multivariate analysis of 341 patients with castration-resistant prostate cancer who were treated in four clinical trials suggested that continued testicular androgen suppression was associated with a median survival benefit of two to six months [4].

               

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Wed Nov 02 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. http://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf (Accessed on April 01, 2014).
  2. Basch E, Loblaw DA, Oliver TK, et al. Systemic therapy in men with metastatic castration-resistant prostate cancer:American Society of Clinical Oncology and Cancer Care Ontario clinical practice guideline. J Clin Oncol 2014; 32:3436.
  3. Fowler JE Jr, Whitmore WF Jr. The response of metastatic adenocarcinoma of the prostate to exogenous testosterone. J Urol 1981; 126:372.
  4. Taylor CD, Elson P, Trump DL. Importance of continued testicular suppression in hormone-refractory prostate cancer. J Clin Oncol 1993; 11:2167.
  5. Suzuki H, Okihara K, Miyake H, et al. Alternative nonsteroidal antiandrogen therapy for advanced prostate cancer that relapsed after initial maximum androgen blockade. J Urol 2008; 180:921.
  6. Scher HI, Liebertz C, Kelly WK, et al. Bicalutamide for advanced prostate cancer: the natural versus treated history of disease. J Clin Oncol 1997; 15:2928.
  7. Joyce R, Fenton MA, Rode P, et al. High dose bicalutamide for androgen independent prostate cancer: effect of prior hormonal therapy. J Urol 1998; 159:149.
  8. Kucuk O, Fisher E, Moinpour CM, et al. Phase II trial of bicalutamide in patients with advanced prostate cancer in whom conventional hormonal therapy failed: a Southwest Oncology Group study (SWOG 9235). Urology 2001; 58:53.
  9. Penson DF, Armstrong AJ, Concepcion R, et al. Enzalutamide Versus Bicalutamide in Castration-Resistant Prostate Cancer: The STRIVE Trial. J Clin Oncol 2016; 34:2098.
  10. Shore ND, Chowdhury S, Villers A, et al. Efficacy and safety of enzalutamide versus bicalutamide for patients with metastatic prostate cancer (TERRAIN): a randomised, double-blind, phase 2 study. Lancet Oncol 2016.
  11. Decensi AU, Boccardo F, Guarneri D, et al. Monotherapy with nilutamide, a pure nonsteroidal antiandrogen, in untreated patients with metastatic carcinoma of the prostate. The Italian Prostatic Cancer Project. J Urol 1991; 146:377.
  12. Pfitzenmeyer P, Foucher P, Piard F, et al. Nilutamide pneumonitis: a report on eight patients. Thorax 1992; 47:622.
  13. Davis NB, Ryan CW, Stadler WM, Vogelzang NJ. A phase II study of nilutamide in men with prostate cancer after the failure of flutamide or bicalutamide therapy. BJU Int 2005; 96:787.
  14. Kassouf W, Tanguay S, Aprikian AG. Nilutamide as second line hormone therapy for prostate cancer after androgen ablation fails. J Urol 2003; 169:1742.
  15. Wysowski DK, Fourcroy JL. Flutamide hepatotoxicity. J Urol 1996; 155:209.
  16. Wysowski DK, Freiman JP, Tourtelot JB, Horton ML 3rd. Fatal and nonfatal hepatotoxicity associated with flutamide. Ann Intern Med 1993; 118:860.
  17. Fosså SD, Slee PH, Brausi M, et al. Flutamide versus prednisone in patients with prostate cancer symptomatically progressing after androgen-ablative therapy: a phase III study of the European organization for research and treatment of cancer genitourinary group. J Clin Oncol 2001; 19:62.
  18. Schröder FH, Collette L, de Reijke TM, Whelan P. Prostate cancer treated by anti-androgens: is sexual function preserved? EORTC Genitourinary Group. European Organization for Research and Treatment of Cancer. Br J Cancer 2000; 82:283.
  19. Small EJ, Halabi S, Dawson NA, et al. Antiandrogen withdrawal alone or in combination with ketoconazole in androgen-independent prostate cancer patients: a phase III trial (CALGB 9583). J Clin Oncol 2004; 22:1025.
  20. Sartor AO, Tangen CM, Hussain MH, et al. Antiandrogen withdrawal in castrate-refractory prostate cancer: a Southwest Oncology Group trial (SWOG 9426). Cancer 2008; 112:2393.
  21. Canipari C, Caroti C, Boccardo F. Re: J. Alfred Witjes. A case of abiraterone acetate withdrawal. Eur Urol 2013;64:517-8. Eur Urol 2014; 65:e54.
  22. Witjes JA. A case of abiraterone acetate withdrawal. Eur Urol 2013; 64:517.
  23. Gauthier H, Bousquet G, Pouessel D, Culine S. Abiraterone acetate withdrawal syndrome: does it exist? Case Rep Oncol 2012; 5:385.
  24. Eisenberger MA, Blumenstein BA, Crawford ED, et al. Bilateral orchiectomy with or without flutamide for metastatic prostate cancer. N Engl J Med 1998; 339:1036.
  25. Eichenberger T, Trachtenberg J, Toor P, Keating A. Ketoconazole: a possible direct cytotoxic effect on prostate carcinoma cells. J Urol 1989; 141:190.
  26. Blum RA, D'Andrea DT, Florentino BM, et al. Increased gastric pH and the bioavailability of fluconazole and ketoconazole. Ann Intern Med 1991; 114:755.
  27. Nishimura K, Nonomura N, Satoh E, et al. Potential mechanism for the effects of dexamethasone on growth of androgen-independent prostate cancer. J Natl Cancer Inst 2001; 93:1739.
  28. Fakih M, Johnson CS, Trump DL. Glucocorticoids and treatment of prostate cancer: a preclinical and clinical review. Urology 2002; 60:553.
  29. Yano A, Fujii Y, Iwai A, et al. Glucocorticoids suppress tumor angiogenesis and in vivo growth of prostate cancer cells. Clin Cancer Res 2006; 12:3003.
  30. Yano A, Fujii Y, Iwai A, et al. Glucocorticoids suppress tumor lymphangiogenesis of prostate cancer cells. Clin Cancer Res 2006; 12:6012.
  31. Venkitaraman R, Lorente D, Murthy V, et al. A randomised phase 2 trial of dexamethasone versus prednisolone in castration-resistant prostate cancer. Eur Urol 2015; 67:673.
  32. Small EJ, Meyer M, Marshall ME, et al. Suramin therapy for patients with symptomatic hormone-refractory prostate cancer: results of a randomized phase III trial comparing suramin plus hydrocortisone to placebo plus hydrocortisone. J Clin Oncol 2000; 18:1440.
  33. Kantoff PW, Halabi S, Conaway M, et al. Hydrocortisone with or without mitoxantrone in men with hormone-refractory prostate cancer: results of the cancer and leukemia group B 9182 study. J Clin Oncol 1999; 17:2506.
  34. Geller J, Albert J, Geller S, et al. Effect of megestrol acetate (Megace) on steroid metabolism and steroid-protein binding in the human prostate. J Clin Endocrinol Metab 1976; 43:1000.
  35. Leinung MC, Liporace R, Miller CH. Induction of adrenal suppression by megestrol acetate in patients with AIDS. Ann Intern Med 1995; 122:843.
  36. Landström M, Damber JE, Bergh A. Estrogen treatment postpones the castration-induced dedifferentiation of Dunning R3327-PAP prostatic adenocarcinoma. Prostate 1994; 25:10.
  37. Manikandan R, Srirangam SJ, Pearson E, et al. Diethylstilboestrol versus bicalutamide in hormone refractory prostate carcinoma: a prospective randomized trial. Urol Int 2005; 75:217.