ABSTRACT
INTRODUCTION Significant progress has been made since the mid 1990s in our ability to treat patients with advanced prostate cancer. Most prostate cancer patients now present with localized disease and mortality rates are dropping.1
Despite the fact that the vast majority of men with prostate cancer are diagnosed with localized disease, current therapies for localized disease will cure only 50% to 85% of patients.2-4 For patients with widespread prostate cancer the disease remains incurable with the currently available agents. Historically, metastatic disease has been treated with androgen deprivation therapy. Despite the extremely high response rates with this modality (>85%), patients universally progress once the cancer transitions to a castration-independent phenotype. Castrationindependent prostate cancer (CIPC) is currently treated with cytotoxic chemotherapy. Work done over the past decade has clearly established that: 1) chemotherapy offers superior palliation (over steroids alone) and improvement of quality of life5; and 2) taxane-based chemotherapy offers a statistically significant, albeit modest, overall survival benefit.6-7 This minor survival benefit achieved with taxanes has been met with great enthusiasm-since it is the first time ever any systemic therapy has been shown to affect overall survival in the CIPC setting. Nonetheless, a median survival of 1.5 years (as reported in the phase III registration trials with docetaxel) can not be seen as the goal but, rather, the starting line for further improvement. New concepts for treatment of advanced prostate cancer are urgently needed.
