The role of chemotherapy in prostate cancer

Hormonal therapy in disseminated prostate cancer is effective in 70-80% of patients and prolongs their lives of a mean 1-2 years. Sooner or later, and rogen independence develops due to a multifactorial mechanism. A smaller pa rt of patients may respond to second-line hormonal manipulations (antiandro gen withdrawal, adrenal enzymes synthesis inhibitors, corticosteroids). In hormone-refractory disease only about 30% of patients would respond to c hemotherapy. In the standard chemotherapy the mostly used cytotoxic agents are anthracyclines, platinum derivatives, vinca alkaloids and cyclophospham ide. However, combined chemotherapy is not more effective than monotherapy. Conventional chemotherapy may improve especially the quality of life. The median survival in chemotherapy patients (6-12 months) is not significantly longer when compared with the best supportive care. In recent years the main concern has been focused on new cytotoxic drugs an d different combinations with hormonal agents. In Phase II studies the comb inations of estramustine with oral etoposide, estramustine with taxanes and alternating weekly regimens (doxorubicin, ketoconazole/estramustine, vinbl astine) show higher response rates (53-69% of patients with prostate-specif ic antigen decline of more than 50%) and longer survival (13-19 months) tha n conventional chemotherapy.