Review ArticlesAndrogen Deprivation Therapy in the Treatment of Advanced Prostate CancerNew Directions in the Management of Advanced Prostate CancerHerbert LeporMark A PerlmutterThis article reviews the issues and controversies relevant to the treatment of advanced prostate cancer with androgen deprivation therapy. Initially, diethylstilbestrol was used for achieving androgen deprivation, but was replaced by luteinizing hormone-releasing hormone (LHRH). Adverse events associated with LHRH agonists include the flare phenomenon, hot flashes, loss of libido, erectile dysfunction, depression, muscle wasting, anemia, and osteoporosis. Intermittent therapy has been advocated to reduce morbidity of treatment. The addition of an antiandrogen provides maximum androgen blockade. There remains controversy regarding the timing of the addition of an antiandrogen. Secondary hormonal therapies include antiandrogens, adrenal androgen inhibitors, and estrogens. [Rev Urol. 2007;9(suppl 1):S3-S8]Androgen deprivation therapyLHRH agonistsAdvanced prostate cancerDiethylstilbestrolMaximum androgen blockade
Review ArticlesCurrent Standard and Investigational Approaches to the Management of Hormone-Refractory Prostate CancerNew Directions in the Management of Advanced Prostate CancerAndrew J ArmstrongDaniel J GeorgePrateek MendirattaProstate cancer is a common cause of death in men and remains incurable in the metastatic setting. In 2004, 2 landmark trials using docetaxel-based chemotherapy, TAX 327 and SWOG 99-16, showed a survival benefit for the first time in metastatic, hormone-refractory prostate cancer. Current research suggests that several distinct mechanisms of androgen-refractory disease may converge in patients with disease progression on androgen deprivation therapy. These findings have identified several potential targets for therapeutic intervention. Current standard and investigational treatment options for this disease are discussed, including chemotherapy and rapidly evolving therapies in phase II/III trials involving antiangiogenic therapies, signal transduction inhibitors, immunomodulatory agents, and nuclear receptor targets. In light of a growing array of treatment options and an increasingly chronic natural history, this review supports a multidisciplinary care approach to these patients, including medical oncologists, urologists, and radiation oncologists, to optimize survival and quality of life. [Rev Urol. 2007;9(suppl 1):S9-S19]ChemotherapyZoledronic acidHormone-refractory prostate cancerAntiangiogenic therapySignal transduction inhibitorsImmunomodulatory agents
Review ArticlesClinical Experience With Gene Therapy for the Treatment of Prostate CancerNew Directions in the Management of Advanced Prostate CancerSimon J HallMatthew A StanizziLocalized prostate cancer can be treated effectively with radical prostatectomy or radiation therapy. The treatment options for metastatic prostate cancer are limited to hormonal therapy; hormone-refractory cancer is treated with taxane-based chemotherapy, which provides only a modest survival benefit. New treatments are needed. The gene for the initiation of prostate cancer has not been identified; however, gene therapy can involve tumor injection of a gene to kill cells, systemic gene delivery to target and kill metastases, or local gene expression intended to generate a systemic response. This review will provide an overview of the various strategies of cancer gene therapy, focusing on those that have gone to clinical trial, detailing clinical experience in prostate cancer patients. [Rev Urol. 2007;9(suppl 1):S20-S28]Prostate cancerProstate-specific antigenGene therapy
Review ArticlesImmunotherapy for Advanced Prostate CancerNew Directions in the Management of Advanced Prostate CancerJohannes ViewegThe absence of curative therapies for advanced or recurrent forms of prostate cancer mandates continued development of novel, more effective treatment regimens. Due to recent advances in basic and translational research, therapeutic vaccines and monoclonal antibody-based therapies are steadily gaining ground as promising treatment modalities against prostate cancer. Several immunotherapeutic products have recently been investigated in later-phase trials and have reported evidence for clinical benefit while maintaining an excellent quality of life for participants. The cumulative clinical results available to date indicate that immune-based therapies will likely play a role in the treatment of patients with prostate and other malignancies. The objective of this article is to increase awareness of contemporary immunologic therapies and clinical trials of new biologic reagents against prostate cancer. We also seek to encourage urologists to actively participate in clinical trials and evaluate the potential of immunotherapeutic drugs for impacting standards of care. [Rev Urol. 2007;9(suppl 1):S29-S38]Prostate cancerImmunotherapyTumor vaccinesMonoclonal antibodies
Review ArticlesSelf-Assessment Post-TestNew Directions in the Management of Advanced Prostate CancerHerbert Lepor