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Year : 2007  |  Volume : 23  |  Issue : 1  |  Page : 67-69

Treatment algorithm in hormone-resistant prostate cancer: Practical guidelines

Department of Uro-oncology, Siddhi Vinayak Ganapati Cancer Hospital, Miraj, India

Correspondence Address:
Makarand V Khochikar
Department of Uro-oncology, Siddhi Vinayak Ganapati Cancer Hospital, Miraj
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-1591.30271

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Treatment of hormone-resistant prostate cancer can be a challenging situation. The first important step in treating this condition is to assess if one has achieved the castrate level or not. If the castrate levels are not achieved, attempt should be made to achieve so. If the castrate level is achieved, then androgen withdrawals may be of help. Supportive care, care of the clinical problems forms an integral part of the treatment. Cancer-specific chemotherapy is certainly an option in progressive disease.

Keywords: Cancer-specific chemotherapy, castrate levels, hormone-resistant prostate cancer, psycho-oncology, secondary hormonal therapy, supportive care

How to cite this article:
Khochikar MV. Treatment algorithm in hormone-resistant prostate cancer: Practical guidelines. Indian J Urol 2007;23:67-9

How to cite this URL:
Khochikar MV. Treatment algorithm in hormone-resistant prostate cancer: Practical guidelines. Indian J Urol [serial online] 2007 [cited 2022 Dec 5];23:67-9. Available from:

The first important step in treating hormone-resistant prostate cancer (HRPC) is to find out if complete castrate levels are achieved or not. It has significant bearing on planning the further course of treatment. If the serum testosterone is at noncastrate level then further androgen suppression should be achieved.[1] If the castrate levels are achieved, then one could have options of either withdrawing antiandrogens or changing antiandrogens or trying intermittent androgen therapy or even trying secondary hormonal therapy. Continued androgen suppression with the same drugs or change of AA has been found to be effective in some patients.[2],[3] Antiandrogen withdrawal has significant effect on the PSA decline - the first report came in 1993 as 'Flutamide withdrawal syndrome'.[4] The overall response could be in the range of 15-33% lasting for more 3.5 + months to more than five months in various studies.[5],[6],[7],[8]

Secondary hormonal therapy also has a significant role to play in HRPC. Its beneficial effect has been found to be in the range of 30-60% with drugs like ketocanazole and aminoglutethimide.[9],[10],[11] Use of diethylstilbestrol has shown a response rate of 20-40% in various studies.[12]

Secondary hormonal therapy may include DES, ketocanazole, prednisolone, finasteride, dutasteride, estramustine, aminoglutethimide, etc.

Secondary orchidectomy has a definite role to play if the castrate levels are not achieved. The response rate would be in the range of 5-70% depending on the prior hormone manipulation used and partly due to inconsistent use of the drugs.[13][22]

   References Top

1.Jeffrey M Kamradt, Kenneth J Pienta. New Paradigms in the Management of Hormone Refractory Disease. In : Klein EA, editor. Management of prostate cancer. Humana Press: Totowa, New Jersey; 2000.  Back to cited text no. 1    
2.Hussain M, Wolf M, Marshall E, Crawford ED, Eisenberger M. Effects of continued androgen-deprivation therapy and other prognostic factors on response and survival in phase II chemotherapy trials for hormone-refractory prostate cancer: A Southwest Oncology Group report. J Clin Oncol 1994;12:1868-75.  Back to cited text no. 2    
3.Taylor CD, Elson P, Trump DL. Importance of continued testicular suppression in hormone-refractory prostate cancer. J Clin Oncol 1993;11:2167-72.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Kelly WK, Scher HI. Prostate specific antigen decline after antiandrogen withdrawal: The Flutamide withdrawal syndrome. J Urol 1993;149:607-9.  Back to cited text no. 4  [PUBMED]  
5.Scher HI, Kelley WK. Flutamide withdrawal syndrome: Its impact on clinical trials in hormone refractory prostate cancer. J Clin Oncol 1993;11:1566-72.  Back to cited text no. 5    
6.Figg WD, Sartor O, Copper MR, Thibault A, Bergan RC, Dawson N, et al . Prostate specific antigen decline following the discontinuation of Flutamide in patients with stage D2 prostate cancer. Am J Med 1995;98:412-4.  Back to cited text no. 6    
7.Small EJ, Srinivas S. The antiandrogen withdrawal syndrome. Experience in a large cohort of unselected patients with advanced prostate cancer. Cancer 1995;76:1428-34.  Back to cited text no. 7    
8.Small EJ, Carroll PR. Prostate specific antigen decline after Casodex withdrawal: Evidence for antiandrogen withdrawal syndrome. Urology 1994;43:408-10.  Back to cited text no. 8  [PUBMED]  
9.Small EJ, Halabi S, Dawson NA, Stadler WM, Rini BI, Picus J, et al . Antiandrogen withdrawal alone or in combination with ketocanazole in androgen-independent prostrate cancer patients: A phase III trial (CALGB 9583). J Clin Oncol 2004;22:1025-33.  Back to cited text no. 9    
10.Small EJ, Baron AD, Fippin L, Apodaca D. Ketocanazole retains activity in advanced prostate cancer patients with progression despite Flutamide withdrawal. J Urol 1997;157:1204-7.  Back to cited text no. 10    
11.Sartor O, Cooper M, Weinberger M, Headlee D, Thibault A, Tompkins A, et al . Surprising activity of Flutamide withdrawal, when combined with aminoglutethimide, in treatment of 'hormone-refractory' prostate cancer. J Natl Cancer Inst 1994;86:222-7.  Back to cited text no. 11    
12.Oh WK, Kantoff PW, Weinberg V, Jones G, Rini BI, Derynck MK, et al . Prospective, multicenter, randomized phase II trial of the herbal supplement, PC-SPES, and diethylstilbestrol in patients with androgen-independent prostate cancer. Clin Oncol 2004;22:3705-12.  Back to cited text no. 12    
13.Stone AR, Hargreave TB, Chisholm GD. The diagnosis of estrogen escape and the role of secondary orchidectomy in prostate cancer. J Urol 1980;52:535-8.  Back to cited text no. 13    
14.Fossa SD, Hosbach G, Paus E. Flutamide in hormone-resistant prostate cancer. J Urol 1990;144:1411-4.  Back to cited text no. 14    
15.Scher HI, Liebertz C, Kelly WK, Mazumdar M, Brett C, Schwartz L, et al . Bicalutamide for advanced prostate cancer: The natural versus treated history of disease. J Clin Oncol 1997;15:2928-38.  Back to cited text no. 15    
16.Kassouf W, Tanguay S, Aprikian AG. Nilutamide as second line hormone therapy for prostate cancer after androgen ablation fails. J Urol 2003;169:1742-4.  Back to cited text no. 16    
17.World Health Organization. Cancer pain relief and palliative care. Report of a WHO Expert committee. World Health Organization Technical Report Series, 804. World Health Organization: Geneva, Switzerland; 1990. p. 1-75.  Back to cited text no. 17    
18.Soerdjbalie-Maikoe V, Pelger RC, Lycklama a Nijeholt GA, Arndt JW, Zwinderman AH, Papapoulos SE, et al . Strontium-89 (Metastron) and the bisphosphonate olpadronate reduce the incidence of spinal cord compression in patients with hormone-refractory prostate cancer metastatic to the skeleton. Eur J Nucl Med Imaging 2002;29:494-8.  Back to cited text no. 18    
19.Iacovou J, Marks JC, Abrams PH, Gingell JC, Ball AJ. Cord compression and carcinoma prostate: Is laminectomy justified. Br J Urol 1985;57:733-6.  Back to cited text no. 19    
20.Albers P, Heicappell R, Schwaibold H, Wolff J; German Association of Urological Oncology, Subdivision of the German Cancer Society. Erythropoietin in urologic oncology. Eur Urol 2001;39:1-8.  Back to cited text no. 20    
21.Moorey S, Greer S, Bliss J, Law M. Comparison of adjuvant psychological therapy and supportive counseling in patients with cancer. Psycho Oncol 1998;7:218-28.  Back to cited text no. 21    
22.Massie MJ, Holland JC. Depression and cancer patient. J Clin Psychiatry 1990;51:12-7.  Back to cited text no. 22    


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