Recent advances in the treatment of prostate cancer

As new evidence for prostate cancer treatment has emerged in the last few y ears, longstanding controversies in the treatment of prostate cancer have r esurfaced. A number of long-held tenets of prostate cancer therapy have bee n revisited, sometimes with surprising and challenging results. Although ne oadjuvant hormonal therapy prior to radical prostatectomy decreases positiv e surgical margin rates, longer follow-up is needed to support survival imp rovement of this combined modality therapy. Androgen deprivation combined w ith radiation therapy appears to improve disease-free survival (and surviva l in one series) in patients with locally advanced cancer. Another approach to locally advanced prostate cancer using three-dimensional conformal radi ation therapy may improve long term outcome. The data are currently insuffi cient to conclude that interstitial low dose rate brachytherapy is equivale nt to conventional treatments: patients with small tumor volumes and low Gl eason grade seem to obtain more benefit, whereas for large tumors with high er gleason grades this approach seems inferior to conventional treatments. In advanced prostate cancer recent data suggest that immediate hormonal the rapy improves survival. In this group of patients the use of maximum androg en blockade remains controversial but may adversely affect quality of life compared to orchiectomy alone. Intermittent hormonal therapy may improve qu ality of life, although effect upon survival is unknown. Chemotherapy in co mbination with androgen deprivation is currently being studied as front-lin e therapy in advanced prostate cancer. Palliative benefit of chemotherapy f or hormone refractory prostate cancer remains an important endpoint; surviv al advantage has not been seen in any randomized trials. Suramin may delay disease progression in hormone refractory prostate cancer. Many aspects of prostate cancer treatment will remain controversial until results of large, randomized trials with longer follow-up are available.