The role of urologists in the management of hormone-refractory prostate cancer

Abstract

In 2001, approximately 80,000 European men will die from hormone-refractory prostate cancer (HRPC), making it one of the leading causes of death among males. Androgen withdrawal is the most effective form of systemic therapy for men with advanced prostate cancer, producing response rates in approximately 80% of patients. The majority of men, however, become refractory to hormonal manipulations and die within a few years. Because HRPC is associated with a median survival that rarely exceeds 12 months, and because there is fear of adding further treatment-related toxicity, many urologists are reluctant to offer chemotherapy to their patients. Even though chemotherapy is not curative for men with HRPC, it may prolong survival and provide palliative effects for some patients. Recent research with newer drugs suggests that prostate cancer may not be as resistant to chemotherapy as previously believed. Therefore, enrollment into clinical trials evaluating chemotherapy in advanced prostate cancer is appropriate. Proper patient selection for chemotherapy is a key role of the urologist because continual care is provided by the urologist, best equipping him or her to direct patients toward appropriate treatment options during the various stages of disease. Caring for a patient with HRPC requires the coordinated efforts of a multidisciplinary team, which should be led by the urologist. © 2002 Elsevier Science B.V. All rights reserved.