ABSTRACT
The stages of cancer of the prostate are summarized in Table 10.1. Although most newly diagnosed patients present with localized tumor, a significant percentage will progress to a metastatic disease. Conventional therapy (surgery, chemotherapy, hormone therapy and radio therapy) controls even advanced disease for a finite period of time. To a significant degree, the growth and division of malignant prostate cells are hormone-dependent. So the most common treatment is androgen deprivation or ablation through surgery, resulting in a clinical response in approximately three-fourths of patients.3 But the term of disease-free survival is not durable, and in a majority of cases it recurs with 12 to 16 months in a disseminated metastatic form that is largely resistant to all standard approaches.4 This hormone-refractory stage is the most ag gressive and has the poorest prognosis, with a medium survival time off less than one year.5 Recent studies suggest that recurrent tumors have a greater cell proliferative capacity and a lower apoptotic index as compared with primary tumors from the same patient.6 Also, ad vanced tumors overcome a microenvironment low in androgen concentration through elevated receptor expression, cross-activation by non-steroidal mechanisms, and mutations in its cog nate receptor allowing for an expanded activation range.7
