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Management of Advanced Prostate Cancer After First-Line Chemotherapy

Dominik R. Berthold, Cora N. Sternberg, Ian F. Tannock

From the Department of Medical Oncology, Princess Margaret Hospital and University of Toronto, Toronto, Canada; and the Division of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy

Address reprint requests to Ian F. Tannock MD, PhD, FRCPC, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada; e-mail: Ian.Tannock{at}uhn.on.ca.

Hormone refractory prostate cancer (HRPC) causes substantial morbidity and mortality. There are increasing options for both first- and second-line therapy in the palliative treatment of patients with HRPC. Medications to control symptoms should first be optimized in patients with late-stage disease, and radiotherapy applied to dominant painful bone lesions. Docetaxel, mitoxantrone, satraplatin, and ixabepilone are active chemotherapeutic agents in the first- and/or second-line setting for patients with HRPC, and this may be true also of older drugs such as oral cyclophosphamide and vinorelbine. Radioisotopes such as strontium and samarium are useful for treatment of more generalized bone pain. Third-line hormonal maneuvers including glucocorticoids, ketoconazole, and estrogens can lead to further palliation in some patients, and there are provocative data that chemotherapy might restore hormonal sensitivity in a subset of patients.

D.R.B. is supported by a Prostate Cancer Research Training Grant to Princess Margaret Hospital from the Canadian Prostate Cancer Research Initiative.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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