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Urology

Volume 9, Supplement 2, 2007

Volume 9, Supplement 2, 2007

Table of Contents

New Paradigms for Advanced Prostate Cancer Androgen-Independent Prostate Cancer
In men with metastatic hormone-refractory prostate cancer, androgen blockade produces dramatic and rapid declines in prostate-specific antigen (PSA), bone pain, and urinary tract obstruction. Nevertheless, there have been limited options with at best palliative results for patients who progress despite a castrate testosterone level. This paradigm changed in 2004 with the publication of 2 randomized clinical trials that demonstrated a 20% to 24% survival benefit for docetaxel-based therapy when compared to mitoxantrone and prednisone, data that supported US Food and Drug Administration approval of docetaxel-based therapy for the treatment of metastatic hormone-refractory prostate cancer. This article reviews the preliminary data and the timing and sequencing implications of ongoing clinical trials. Studies are evaluating the combination of docetaxel with agents that target bone, tumor vasculature, and the vitamin D receptor as well as second-line agents, such as satraplatin. The role of immune therapy is also evolving, and further studies will define the optimal timing of chemotherapy with immune therapy. [Rev Urol. 2007;9(suppl 2):S3-S12]
Treatment Options for Hormone-Refractory Prostate Cancer Androgen-Independent Prostate Cancer
Hormone-refractory prostate cancer is a disease that includes a variety of patients and represents a treatment dilemma for the practicing physician. Because of the diversity of this group, management strategies must be targeted to the clinical situations of the individual patients and their wishes. This article outlines a logical progression of treatment choices that currently exist in this rapidly evolving field, and the landmark chemotherapy trials involving docetaxel (SWOG 9916 and TAX 327) are reviewed. Although significant progress has been made in understanding and treating hormonerefractory prostate cancer, current treatments do not yet provide a cure, and important clinical trials continue to recruit patients. [Rev Urol. 2007;9(suppl 2):S13-S18]
High-Risk, Clinically Localized Prostate Cancer: Is Monotherapy Adequate? Androgen-Independent Prostate Cancer
High-risk, clinically localized prostate cancer represents a diverse disease entity. Patients who are considered to be at highest risk for biochemical failure after localized treatments may not be at significant risk for diseasespecific mortality. In this review, an attempt will be made to define high-risk status and help identify patients at high risk for mortality after a diagnosis of localized prostate cancer. Subsequently, a review of monotherapy approaches as well as previously successful strategies utilizing multimodality therapy for high-risk disease will be presented. Finally, a synopsis will be given of several ongoing randomized clinical trials using the most effective systemic therapies in the adjuvant setting following thorough local treatments such as radical prostatectomy. This review will provide a glimpse into the future and describe the tools that it is hoped will improve further upon the results of surgical monotherapy for high-risk, localized prostate cancer. [Rev Urol. 2007;9(suppl 2):S19-S27]
Breast Cancer Clinical and Translational Research: Analogies and Implications for Prostate Cancer Androgen-Independent Prostate Cancer
Breast and prostate cancer, respectively, are the most common cancers in women and in men in the United States. The management of locally advanced prostate cancer involves a multidisciplinary approach, bearing similarity to the therapeutic approach to breast cancer. Better understanding of the molecular biology of these cancers and the identification of the role played by the cancer stem cells and the tumor microenvironment may translate into better clinical decision making regarding risk classification and treatment allocation. A systematic assessment is presented of the many parallel evolutions in defining and treating high-risk breast cancer as they pertain to prostate cancer. [Rev Urol. 2007;9(suppl 2):S28-S39]
Self-Assessment Post-Test Androgen-Independent Prostate Cancer