General treatment of metastatic prostatic cancer

Most of advanced prostatic carcinoma are hormono-sensitive. The use of combined androgen blockade (CAB) appears to improve survival and quality of life but only with the use of chemical castration by LH-RH analogue and non steroidal antiandrogen. After CAB, further hormonal maneuvers remain efficacious as in a first time antiandrogen withdrawal before estrogens, aromatase inhibitors and after hormone resistance, chemotherapy. In bone lesions, bisphosphonates and strontium 89 produce pain relief. The use of new methods for evaluation for response and quality of life will allow the rapid identification of effective treatments and powered phase III trials.