Skip to main content
Log in

The spectrum of prostate cancer care: From curative intent to palliation

Current Prostate Reports

Abstract

Prostate cancer is one of the most prevalent malignancies affecting men in the developed world. A spectrum of disease states exists and management is tailored to individual patients. Increasing public awareness and prostate-specific antigen testing have led to earlier detection and the possibility of cure but have increased the risk of overtreatment of indolent disease. Advances in curative modalities have reduced side effects and offer patients a choice of treatments. Nonetheless, many need no intervention and may be safely treated with active monitoring. Choice and timing of therapy for locally advanced and recurrent disease are variable, with potential benefits of early intervention counterbalanced by side effects of treatment. Progress has been made in the management of advanced disease; skeletal-related events have been reduced and survival has been increased. This review examines the evidence and rationale behind the treatment options from curative intent to management of locally advanced disease and palliation of metastatic disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References and Recommended Reading

  1. American Cancer Society: How many men get prostate cancer? Available at http://www.cancer.org/docroot/CRI/content/CRI_2_2_1X_How_many_men_get_prostate_cancer_36.asp?sitearea=. Accessed March 17, 2008.

  2. Stamey TA, McNeal JE, Yemoto CM, et al.: Biological determinants of cancer progression in men with prostate cancer. JAMA 1999, 281:1395–1400.

    Article  PubMed  CAS  Google Scholar 

  3. Albertsen PC, Hanley JA, Fine J: 20 Year outcomes following conservative management of clinically localized prostate cancer. JAMA 2005, 293:2095–2101.

    Article  PubMed  CAS  Google Scholar 

  4. Bill-Axelson A, Holmberg L, Ruutu M, et al.: Scandinavian Prostate Cancer Group Study No. 4. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 2005, 352:1977–1984.

    Article  PubMed  CAS  Google Scholar 

  5. Steyerberg EW, Roobol MJ, Kattan MW, et al.: Prediction of indolent prostate cancer: validation and updating of a prognostic nomogram. J Urol 2007, 177:107–112.

    Article  PubMed  CAS  Google Scholar 

  6. Klotz L: Active surveillance with selective delayed intervention using PSA doubling time for good risk prostate cancer. Eur Urol 2005, 47:16–21.

    Article  PubMed  Google Scholar 

  7. Walsh PC, Donker PJ: Impotence following radical prostatectomy: insight into etiology and prevention. J Urol 1982, 128:492–497.

    PubMed  CAS  Google Scholar 

  8. Lu-Yao GL, Yao SL: Population-based study of long-term survival in patients with clinically localised prostate cancer. Lancet 1997, 349:906–910.

    Article  PubMed  CAS  Google Scholar 

  9. Bianco FJ Jr, Guillonneau B: Laparoscopic radical prostatectomy: an evolution in surgery. Minerva Chir 2005, 60:351–362.

    PubMed  Google Scholar 

  10. Smith JA Jr, Herrell SD: Robotic-assisted laparoscopic prostatectomy: do minimally invasive approaches offer significant advantages? J Clin Oncol 2005, 23:8170–8175.

    Article  PubMed  Google Scholar 

  11. Zietman AL, DeSilvio ML, Slater JD, et al.: Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: a randomized controlled trial. JAMA 2005, 294:1233–1239.

    Article  PubMed  CAS  Google Scholar 

  12. Sathya JR, Davis IR, Julian JA, et al.: Randomized trial comparing iridium implant plus external-beam radiation therapy with external-beam radiation therapy alone in node-negative locally advanced cancer of the prostate. J Clin Oncol 2005, 23:1192–1199.

    Article  PubMed  Google Scholar 

  13. Grills IS, Martinez AA, Hollander M, et al.: High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds. J Urol 2004, 171:1098–1104.

    Article  PubMed  Google Scholar 

  14. Pilepich MV, Krall JM, al-Sarraf M, et al.: Androgen deprivation with radiation therapy compared with radiation therapy alone for locally advanced prostatic carcinoma: a randomized comparative trial of the Radiation Therapy Oncology Group. Urology 1995, 45:616–623.

    Article  PubMed  CAS  Google Scholar 

  15. D’Amico AV, Manola J, Loffredo M, et al.: 6-Month androgen suppression plus radiation therapy vs radiation therapy alone for patients with clinically localized prostate cancer: a randomized controlled trial. JAMA 2004, 292:821–827.

    Article  PubMed  Google Scholar 

  16. Vicini FA, Martinez A, Hanks G, et al.: An interinstitutional and interspecialty comparison of treatment outcome data for patients with prostate carcinoma based on predefined prognostic categories and minimum follow-up. Cancer 2002, 95:2126–2135.

    Article  PubMed  Google Scholar 

  17. Donovan J, Hamdy F, Neal D, et al.: ProtecT Study Group. Prostate Testing for Cancer and Treatment (ProtecT) feasibility study. Health Technol Assess 2003, 7:1–88.

    PubMed  CAS  Google Scholar 

  18. Langley SE, Laing R: Prostate brachytherapy has come of age: a review of the technique and results. BJU Int 2002, 89:241–249.

    Article  PubMed  CAS  Google Scholar 

  19. Penson DF, Feng Z, Kuniyuki A, et al.: General quality of life 2 years following treatment for prostate cancer: what influences outcomes? Results from the Prostate Cancer Outcomes Study. J Clin Oncol 2003, 21:1147–1154.

    Article  PubMed  Google Scholar 

  20. Swindle PW, Kattan PW, Scardino PT: Markers and meaning of primary treatment failure. Urol Clin North Am 2003, 30:377–401.

    Article  PubMed  Google Scholar 

  21. Pound CR, Partin AW, Eisenberger MA, et al.: Natural history of progression after PSA elevation following radical prostatectomy. JAMA 1999, 281:1591–1597.

    Article  PubMed  CAS  Google Scholar 

  22. Lawton CA, Winter K, Grignon D, Pilepich MV: Androgen suppression plus radiation versus radiation alone for patients with stage D1/pathologic node-positive adenocarcinoma of the prostate: updated results based on national prospective randomized trial Radiation Therapy Oncology Group 85-31. J Clin Oncol 2005, 23:800–807.

    Article  PubMed  Google Scholar 

  23. McLeod DG, Iversen P, See WA, et al., Casodex Early Prostate Cancer Trialists’ Group: Bicalutamide 150 mg plus standard care vs standard care alone for early prostate cancer. BJU Int 2006, 97:247–254.

    Article  PubMed  CAS  Google Scholar 

  24. Stephenson AJ, Shariat SF, Zelefsky MJ, et al.: Salvage radiotherapy for recurrent prostate cancer after radical prostatectomy. JAMA 2004, 291:1325–1332.

    Article  PubMed  CAS  Google Scholar 

  25. Bolla M, van Poppel H, Collette L, et al.: European Organization for Research and Treatment of Cancer. Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet 2005, 366:572–578.

    Article  PubMed  Google Scholar 

  26. Thompson IM, Tangen CM, Paradelo J, et al.: Adjuvant radiotherapy for pathologically advanced prostate cancer. JAMA 2006, 296:2329–2335.

    Article  PubMed  CAS  Google Scholar 

  27. Sanderson KM, Penson DF, Cai J, et al.: Salvage radical prostatectomy: quality of life outcomes and long-term oncological control of radiorecurrent prostate cancer. J Urol 2006, 176:2025–2031.

    Article  PubMed  Google Scholar 

  28. Ward JF, Slezak JM, Blute ML, et al.: Radical prostatectomy for clinically advanced (cT3) prostate cancer since the advent of prostate-specific antigen testing: 15 year outcome. BJU Int 2005, 95:751–756.

    Article  PubMed  Google Scholar 

  29. Nilsson S, Norlen BJ, Widmark A: A systematic overview of radiation therapy effects in prostate cancer. Acta Oncol 2004, 43:316–381.

    Article  PubMed  Google Scholar 

  30. Bolla M, Collette L, Blank L, et al.: Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet 2002, 360:103–106.

    Article  PubMed  CAS  Google Scholar 

  31. Fowler JE Jr, Bigler SA, White PC, Duncan WL: Hormone therapy for locally advanced prostate cancer. J Urol 2002, 168:546–549.

    Article  PubMed  CAS  Google Scholar 

  32. Horwich A, Huddart RA, Gadd J, et al.: A pilot study of intermittent androgen deprivation in advanced prostate cancer. Br J Urol 1998, 81:96–99.

    Article  PubMed  CAS  Google Scholar 

  33. Byar DP, Corle DK: Hormone therapy for prostate cancer: results of the Veterans Administration Cooperative Urological Research Group Studies. NCI Monogr 1988, 7:165–170.

    PubMed  Google Scholar 

  34. The Medical Research Council Prostate Cancer Working Party Investigators Group: Immediate versus deferred treatment for advanced prostatic cancer: initial results of the Medical Research Council Trial. Br J Urol 1997, 79:235–246.

    Article  Google Scholar 

  35. Ryan CJ, Small EJ: Early versus delayed androgen deprivation for prostate cancer: new fuel for an old debate. J Clin Oncol 2005, 23:8225–8231.

    Article  PubMed  CAS  Google Scholar 

  36. Studer UE, Whelan P, Albrecht W, et al.: Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer (EORTC) Trial 30891. J Clin Oncol 2006, 24:1868–1876.

    Article  PubMed  Google Scholar 

  37. Mason MD, on behalf of the MRC PR04 collaborators: Development of bone metastases from prostate cancer: first results of the MRC PR04 trial (ISCRTN 61384873) [abstract 4511]. Proc Am Soc Clin Oncol 2004, 22:384S.

    Google Scholar 

  38. Smith MR, Kabbinavar F, Saad F, et al.: Natural history of rising serum prostate-specific antigen in men with castrate nonmetastatic prostate cancer. J Clin Oncol 2005, 23:2918–2925.

    Article  PubMed  Google Scholar 

  39. Pruthi RS, Derksen Je, Moore D, et al.: Phase II trial of celecoxib in prostate-specific antigen recurrent prostate cancer after definitive radiation therapy or radical prostatectomy. Clin Cancer Res 2006, 12:2172–2177.

    Article  PubMed  CAS  Google Scholar 

  40. Systemic Therapy in Advancing or Metastatic Prostate cancer: Evaluation of Drug Efficacy (STAMPEDE): a multiarm multi-stage randomised controlled trial (MAMS RCT). Available at http://www.stampede.bham.ac.uk. Accessed February 1, 2007.

  41. Di Lorenzo G, Autorino R, Ciardiello F, et al.: External beam radiotherapy in bone metastatic prostate cancer: impact on patients’ pain relief and quality of life. Oncol Rep 2003, 10:399–404.

    PubMed  Google Scholar 

  42. Lin A, Ray ME: Targeted and systemic radiotherapy in the treatment of bone metastasis. Cancer Metastasis Rev 2006, 25:669–675.

    Article  PubMed  Google Scholar 

  43. Quality PM, Kirk D, Bolger JJ, et al.: A comparison of the palliative effects of strontium-89 and external beam radiotherapy in metastatic prostate cancer. Radiother Oncol 1994, 31:33–40.

    Article  Google Scholar 

  44. Oosterhof GO, Roberts JT, de Reijke TM, et al.: Strontium(89) chloride versus palliative local field radiotherapy in patients with hormonal escaped prostate cancer: a phase III study of the European Organisation for Research and Treatment of Cancer, Genitourinary Group. Eur Urol 2003, 44:519–526.

    Article  PubMed  CAS  Google Scholar 

  45. Collins C, Eary JF, Donaldson G, et al.: Samarium-153-EDTMP in bone metastases of hormone refractory prostate carcinoma: a phase I/II trial. J Nucl Med 1993, 34:1839–1844.

    PubMed  CAS  Google Scholar 

  46. Saad F, Gleason DM, Murray R, et al.: Long-term efficacy of zoledronic acid for the prevention of skeletal complications in patients with metastatic hormone-refractory prostate cancer. J Natl Cancer Inst 2004, 96:879–882.

    Article  PubMed  CAS  Google Scholar 

  47. Small EJ, Smith MR, Seaman JJ, et al.: Combined analysis of two multicenter, randomized, placebo-controlled studies of pamidronate disodium for the palliation of bone pain in men with metastatic prostate cancer. J Clin Oncol 2003, 21:4277–4284.

    Article  PubMed  CAS  Google Scholar 

  48. Tannock IF, Osoba D, Stockler MR, et al.: Chemotherapy with mitoxantrone plus prednisone or prednisone alone for symptomatic hormone-resistant prostate cancer: a Canadian randomized trial with palliative end points. J Clin Oncol 1996, 14:1756–1764.

    PubMed  CAS  Google Scholar 

  49. Tannock IF, de Wit R, Berry WR, et al.: Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med 2004, 351:1502–1512.

    Article  PubMed  CAS  Google Scholar 

  50. Petrylak DP, Tangen CM, Hussain MH, et al.: Docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer. N Engl J Med 2004, 351:1513–1520.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Freddie C. Hamdy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ali, A.S.M., Hamdy, F.C. The spectrum of prostate cancer care: From curative intent to palliation. Curr prostate rep 6, 56–63 (2008). https://doi.org/10.1007/s11918-008-0010-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11918-008-0010-6

Keywords

Navigation