Chemotherapy of advanced prostatic carcinoma

Metastatic prostate cancer remains incurable. Historically, therapy options for patients with nonlocalized disease have been limited to hormonal therapy and palliative radiation therapy. The use of cytotoxic chemotherapy has not been routine, and is still not rigorously demonstrated to alter the natural history of androgen-independent prostate cancer. Nonetheless, there is an established, if not universally accepted, role for chemotherapy in symptom palliation, and several combinations have been described that produce response rates in the range that are associated with alteration of disease progression and improved survival in other cancers. The further refinement of such combination regimens, and their application to patients much earlier in the course of the disease, are the most important immediate challenges for medical oncologists who treat prostate cancer. At present, the curative potential of all local therapies remains disappointing; it is expected that the advent of truly effective systemic therapy will bring much improved prospects for cure by the application of combined modality treatment.