Indian Journal of Urology
: 2007  |  Volume : 23  |  Issue : 1  |  Page : 67--69

Treatment algorithm in hormone-resistant prostate cancer: Practical guidelines

Makarand V Khochikar 
 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


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.

How to cite this article:
Khochikar MV. Treatment algorithm in hormone-resistant prostate cancer: Practical guidelines.Indian J Urol 2007;23:67-69

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Khochikar MV. Treatment algorithm in hormone-resistant prostate cancer: Practical guidelines. Indian J Urol [serial online] 2007 [cited 2022 Sep 30 ];23:67-69
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Full Text

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]


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