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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. List the risk factors associated with the development of prostate cancer.

  2. Compare placebo versus finasteride for the prevention of prostate cancer.

  3. Recommend an initial treatment for prostate cancer on the basis of stage, Gleason score, prostate-specific antigen, patient age, and symptoms.

  4. Select an initial and secondary hormonal manipulation for newly diagnosed advanced prostate cancer

  5. Understand the role of chemotherapy and immunotherapy in the treatment of metastatic castrate-resistant prostate cancer.

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KEY CONCEPTS

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  • Image not available. Prostate cancer is the most frequent cancer in U.S. men. Increasing age and family history are the primary risk factors for prostate cancer.

  • Image not available. Prostate-specific antigen (PSA) is a useful marker for predicting outcome for localized disease and monitoring response to androgen-deprivation therapy or chemotherapy for advanced-stage disease. An elevated PSA may detect asymptomatic prostate cancer at an early stage.

  • Image not available. The prognosis for prostate cancer patients depends on the histologic grade, tumor size, and disease stage. More than 85% of patients with stage 1 disease but fewer than 1% of those with stage D can be cured.

  • Image not available. Androgen ablation with a luteinizing hormone–releasing hormone (LHRH) agonist plus an antiandrogen should be used before radiation therapy for patients with locally advanced prostate cancer to improve outcomes over radiation therapy alone.

  • Image not available. Androgen ablation therapy with orchiectomy, an LHRH agonist alone or an LHRH agonist plus an antiandrogen (combined hormonal blockade) can be used to provide palliation for patients with advanced (stage D) prostate cancer. The effects of androgen deprivation are most pronounced in patients with minimal disease at diagnosis.

  • Image not available. For patients having progressive disease while receiving combined hormonal blockade with an LHRH agonist plus an antiandrogen, antiandrogen withdrawal can provide additional symptomatic relief. Mutations in the androgen receptor have been documented that cause antiandrogen compounds to behave like receptor agonists.

  • Image not available. Chemotherapy with docetaxel and prednisone improves survival in patients with castrate-resistant prostate cancer (CRPC).

  • Image not available. Chemotherapy with cabazitaxel and prednisone improves survival in patients with CRPC who have either progressed or are intolerant to docetaxel

  • Image not available. Hormonal manipulation with abiraterone and prednisone improves survival in patients previously treated with docetaxel and prednisone.

  • Image not available. Immunotherapy with sipuleucel-T improves survival in patients with minimally symptomatic CRPC.

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INTRODUCTION

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Prostate cancer is the most commonly diagnosed cancer in U.S. men.1 The disease course varies from a slow growing, asymptomatic tumor that may not require treatment to a rapidly progressing, aggressive tumor resulting in mortality. Prostate cancers are hormonally sensitive, and their growth is increased by androgen signaling. In most men, prostate cancer has a prolonged course. The treatment of clinically localized prostate cancer is based on risk features that may predict a more aggressive cancer. Treatment options for clinically localized disease include active surveillance (also referred to as observation, or watchful waiting) for low-risk patients to surgery, and/or radiation for higher risk patients. With active surveillance, patients are monitored for disease progression ...

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