Introduction: Challenges in the Treatment of Advanced Symptomatic Prostate Cancer Patients

INTRODUCTION Challenges in the Treatment of Advanced Symptomatic Prostate Cancer Patients E. David Crawford, MD Supplement Editor, Challenges in the Treatment of Advanced Symptomatic Prostate Cancer Patients; Section of Urologic Oncology, University of Colorado at Denver and Health Sciences Center, Aurora, CO [Rev Urol. 2004;6(suppl 7):S1-S2] © 2004 MedReviews, LLC espite the fact that prostate cancer remains the second leading cause of cancer deaths among men, and for men over the age of 45 the fifth leading cause of death overall, we continue to see improvements in screening methods and treatment effectiveness. Advances in detection methods, including prostate-specific antigen testing, have led to early detection in prostate-cancer diagnosis, and new treatments continue to emerge. This supplement to Reviews in Urology discusses hormonal therapy, which continues to be one of the treatment standards for advanced stage disease. The supplement opens with my article, where I discuss hormonal therapy from its historical roots in the 1940s, the development of luteinizing hormone-releasing hormone (LHRH) agonists in the 1980s, to today when the use of combination therapy, or combined androgen blockade, as well as new chemotherapeutic agents, are showing renewed interest in the fight against advanced prostate disease. The debate over LHRH agonists is addressed by Michael K. Brawer, MD, who discusses the challenges with LHRH agonists, including the resulting phenomena of flare and surge, which raise awareness of the possibility of increased mortality rates from this therapy. D VOL. 6 SUPPL. 7 2004 REVIEWS IN UROLOGY S1 Introduction continued The role of gonadotropin-releasing hormone (GnRH) antagonists, such as abarelix, which represent the newest class of agents in hormonal therapy, is presented by Shandra Wilson, MD, who gives an in-depth review of the advantages of GnRH antagonists over LHRH agonists and the benefits of neoadjuvant androgen deprivation therapy. Frans M. J. Debruyne, MD, PhD, presents a comprehensive overview of prostate cancer and sheds light on the mechanism of GnRH antagonist. This informative article then presents a discussion of GnRH therapy in S2 VOL. 6 SUPPL. 7 2004 studies conducted to show the efficacy of abarelix, alone or in combination with bicalutamide, in reducing serum testosterone to castrate levels more rapidly than LHRH agonists. Tomasz M. Beer, MD, also discusses ongoing studies with abarelix in reducing serum follicle-stimulating hormone levels and the use of GnRH antagonists in second-line hormonal therapy. This therapy appears to be very encouraging and has led to a phase I trial to determine whether an escalation in abarelix dosage is safe and effective. In addition, 4 case reports on REVIEWS IN UROLOGY prostate cancer by Mario A. Eisenberger, MD, and Leonard Michael Glode, MD, illustrate the discussion topics. Each presents a clinical case, followed by a diagnosis, treatment options, and a full, indepth discussion. I believe you will find the discussions and case reviews in this supplement to be useful and informative in presenting the history of hormonal therapy all the way through to the current and developing forms of treatment in the ongoing battle against this disease.