Advanced Prostate Cancer: Hormones and Beyond

Bilateral orchiectomy became the "gold standard" treatment option for advanced prostate cancer following the Nobel Prize winning study by Huggins and Hodges in 1941. Almost 40 yr later, the combination of a nonsteroidal antiandrogen with castration-based treatment (combined androgen blockade [CAB]) was proposed to offer superior response and survival compared with castration alone. However, 25 yr and many randomised studies later, the benefit of CAB remains controversial. Here, we present a clinical scenario that describes a patient with advanced prostate cancer and we review the available treatment options. The first part of the article focuses on androgen-dependent disease, comparing castration (surgical or medical) to either Casodex™ (bicalutamide) 150 mg monotherapy or CAB. In the CAB setting, Casodex 50 mg combined with castration-based therapy is calculated to reduce the rate of all-cause mortality by an estimated 20% compared with castration alone. The second part of the article describes treatment options for androgen-independent prostate cancer, including alternative forms of hormonal therapy, such as oestrogen therapy and ketoconazole- and docetaxel-based chemotherapy.