Prostate cancer is one of the commonest cancers in men in the western world, and the prevalence is rising currently due to improvements in screening and treatment. Serum PSA represents a useful marker of disease. It has frequently a long natural history, creating the opportunities for multiple sequential therapeutic interventions. For patients with high risk local disease or with metastases, endocrine therapy is central to management. Hormone ablation has long been the mainstay of endocrine therapy in this group of patients, though anti-androgens, oestrogens and corticosteroids can also cause remissions. In recent years effective and well-tolerated chemotherapy regimens have been developed and evaluated. Docetaxel has an established role, and a range of biologically-targeted agents are in development. The dominant pattern of metastatic spread is to the axial skeleton and most symptomatic care is directed to palliation of bone pain. The role of bisphosphonates remains controversial, but bone-directed isotopes such as Strontium-89 are effective.
Part of the Oxford Oncology Library, this pocketbook summarises the up-to-date information on the use of systemic therapies in the management of prostate cancer (early stage, metastatic disease, and treatment of "biochemical" recurrence). With contributions from leading oncologists from both Europe and the USA, the book provides a practical guide to the range of endocrine and cytotoxic therapies currently available to clinicians, as well as to other palliative anticancer strategies, and will be valuable to all health professionals involved in the management of patients with prostate cancer.
Alan Horwich is Professor of Oncology at the Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK.
1. Biological principles of hormone therapy ; 2. PSA as a marker of progression and response ; 3. Neoadjuvant and adjuvant hormone therapy for high-risk localized disease ; 4. Systemic treatment of recurrence after local therapies ; 5. First-line hormone therapy for metastatic prostate cancer ; 6. Second- and third-line hormone therapies ; 7. Chemotherapy for metastatic prostate cancer ; 8. The role of bisphosphonates in prostate cancer ; 9. Systemic isotope therapy of bone metastasis ; 10. The development of biologically targeted agents