Skip to main content

Advertisement

SpringerLink
Log in

Prostate Cancer

Incidence, Management and Outcomes

  • Review Article
  • Disease Management
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

The incidence of prostate carcinoma in the US now appears to be declining slightly, as a consequence of removal of prevalent cases from the population by screening. Screening for serum prostate-specific antigen (PSA) levels has been improved by the use of PSA transformations including PSA density, PSA velocity and age-specific PSA reference ranges. The ratio of free to total PSA may increase the specificity of single serum PSA evaluations without decreasing its sensitivity for the diagnosis of prostate cancer.

Despite the proliferation of risk assessment tools and nomograms, the optimal therapy for localised disease remains controversial, and the usefulness of radical prostatectomy or radiation therapy (either external beam or brachytherapy) has not been tested prospectively against watchful waiting. However, watchful waiting is probably more appropriate for men whose life expectancy is less than 10 to 15 years and/or who have low grade tumours.

In patients with metastatic disease, androgen deprivation remains the mainstay of treatment. Whether or not the addition of an antiandrogen prolongs survival remains controversial. Intermittent androgen deprivation appears to be one means of avoiding continuous androgen deprivation and possibly decreasing adverse effects, although its efficacy remains to be proven. For patients whose disease progresses after combined androgen blockade, withdrawal of antiandrogen is now considered mandatory. Tremendous heterogeneity exists among patients who progress after antiandrogen withdrawal, so that patients previously considered resistant to hormones may in fact retain some hormonal sensitivity to second- or third-line hormone therapy.

For patients with hormone-refractory prostate cancer, a variety of options exist, including the use of estramustine combinations, suramin, mitoxantrone and doxorubicin combinations. Despite these options, there is presently no standard of care, and clinical trials should receive priority. Palliative interventions, including the use of corticosteroids, radiopharmaceuticals and external beam radiation therapy, should not be overlooked.

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

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Parker SL, Tong T, Bolden S, et al. Cancer statistics, 1996. CA Cancer J Clin 1996; 65: 5–27

    Article  Google Scholar 

  2. Mettlin C, Murphy GP, Ho R, et al. The National Cancer Database report on longitudinal observations on prostate cancer. Cancer 1996; 77: 2162–6

    Article  PubMed  CAS  Google Scholar 

  3. Stephenson R, Smart CR, Mineau GP, et al. The fall in incidence of prostate carcinoma: on the down side of a prostate specific antigen induced peak in incidence — data from the Utah Cancer Registry. Cancer 1996; 77: 1342–8

    Article  PubMed  CAS  Google Scholar 

  4. Haas GP, Sakr WA. Epidemiology of prostate cancer. CA Cancer J Clin 1997; 47: 273–88

    Article  PubMed  CAS  Google Scholar 

  5. Giovannuci E, Aschero A, Rimm EB, et al. Intake of carotenoids and retinol in relation to risk of prostate cancer. J Natl Cancer Inst 1995; 87: 1767–76

    Article  Google Scholar 

  6. Smith JR, Freije D, Carpten JD, et al. Major susceptibility locus for prostate cancer on chromosome 1 suggested by a genome-wide search. Science 1996; 274: 1371–4

    Article  PubMed  CAS  Google Scholar 

  7. Carter HB, Pearson JD, Metter EJ, et al. Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. JAMA 1992; 267: 2215–20

    Article  PubMed  CAS  Google Scholar 

  8. Kadmon D, Williams RH, Pavlik VN, et al. Pitfalls in interpreting prostate specific antigen velocity. J Urol 1996; 155: 1655–7

    Article  PubMed  CAS  Google Scholar 

  9. Morgan TO, Jacobsen SJ, McCarthy WF, et al. Age-specific reference ranges for prostate-specific antigen in black men [comments]. N Engl J Med 1996; 335: 304–10

    Article  PubMed  CAS  Google Scholar 

  10. Partin AW, Criley SR, Subong EN, et al. Standard versus age-specific antigen reference ranges among men with clinically localized prostate cancer: a pathological analysis. J Urol 1996; 155: 1336–9

    Article  PubMed  CAS  Google Scholar 

  11. Adolfsson J, Carstensen J, Lowhagen T. Deferred treatment in clinically localized prostatic carcinoma. Br J Urol 1992; 69: 183–7

    Article  PubMed  CAS  Google Scholar 

  12. Aus G, Hugosson J, Norlen L. Long-term survival and mortality in prostate cancer treated with noncurative intent. J Urol 1995; 154: 460–5

    Article  PubMed  CAS  Google Scholar 

  13. Catalona W, Smith D, Wolfert R, et al. Evaluation of percentage of free serum prostate specific antigen to improve specificity of prostate cancer screening. JAMA 1995; 274: 1214–20

    Article  PubMed  CAS  Google Scholar 

  14. Demura TS, Tanaka M, Enami N, et al. The proportion of free to total prostate specific antigen induced peak in incidence-data from the Utah Cancer Registry. Utah Cancer Registry 1996; 77: 1342–8

    Google Scholar 

  15. Filella XA, Molina R, Gimenez N, et al. Clinical usefulness of free PSA fraction as an indicator of prostate cancer. Int J Cancer 1995; 63: 780–4

    Article  PubMed  CAS  Google Scholar 

  16. Oesterling JE, Jacobsen SJ, Klee GG, et al. Free, complexed, and total serum prostate specific antigen: the establishment of appropriate reference ranges for the concentrations and ratios. J Urol 1995; 154: 1594–8

    Article  Google Scholar 

  17. Lerner SJ, Lilja H, Bergstralh EJ, et al. Free, complexed, and total serum prostate-specific antigen concentrations and their proportions in predicting stage, grade, and deoxyribonucleic acid ploidy in patients with adenocarcinoma of the prostate. Urology 1996; 48: 240–8

    Article  PubMed  CAS  Google Scholar 

  18. Schwartz KL, Severson RK, Gurney JG, et al. Trends in the stage specific incidence of prostate carcinoma in the Detroit metropolitan area, 1973–1994. Cancer 1996; 78: 1260–6

    Article  PubMed  CAS  Google Scholar 

  19. Partin AW, Kattan MW, Subong EN, et al. Combination of prostate-specific antigen, clinical stage, and Gleason Score to predict pathological state of localized prostate cancer: a multi-institutional update. JAMA 1997; 277: 1445–51

    Article  PubMed  CAS  Google Scholar 

  20. Olsson CA, de Vries GM, Raffo AJ, et al. Preoperative reverse transcriptase polymerase chain reaction for prostate specific antigen predicts treatment failure following radical prostatectomy. J Urol 1996; 155: 1661–2

    Article  Google Scholar 

  21. Seiden MV, Kantoff PW, Krithivas K, et al. Detection of circulating tumor cells in men with localized prostate cancer. J Clin Oncol 1994; 12: 2634–9

    PubMed  CAS  Google Scholar 

  22. Robinson JW, Dufour MS, Fung TS. Erectile functioning of men treated for prostate cancer. Cancer 1997; 79: 5338–44

    Article  Google Scholar 

  23. Eastham JA, Kattan MW, Rogers E, et al. Risk factors for urinary incontinence after radical prostatectomy. J Urol 1996; 156: 1707–13

    Article  PubMed  CAS  Google Scholar 

  24. Soloway M, Sharifi R, Wajsman Z, et al. Randomized prospective study comparing radical prostatectomy alone versus radical prostatectomy preceded by androgen blockade in clinical stage B2 (T2bNxM0) prostate cancer. J Urol 1995; 154: 424–8

    Article  PubMed  CAS  Google Scholar 

  25. Labrie F, Cusan L, Gomez JL, et al. Neoadjuvant hormonal therapy: the Canadian experience. Urology 1997; 49: 56–64

    Article  PubMed  CAS  Google Scholar 

  26. Abbas F, Scardino PT. Why neoadjuvant androgen deprivation prior to radical prostatectomy is unnecessary. Urol Clin North Am 1996; 23: 587–604

    Article  PubMed  CAS  Google Scholar 

  27. Witjes WP, Schulman CC, Debruyne FM. Preliminary results of a prospective randomized study comparing radical prostatectomy versus radical prostatectomy associated with neoadjuvant hormonal combination therapy in T2-3 N0 M0 prostatic carcinoma. The European Study Group on Neoadjuvant Treatment of Prostate Cancer. Urology 1997; 49: 65–9

    Article  PubMed  CAS  Google Scholar 

  28. Bazinet M, Zheng W, Begin LR, et al. Morphologic changes induced by neoadjuvant androgen ablation may result in underdetection of positive surgical margins and capsular involvement by prostatic adenocarcinoma. Urology 1997; 49: 721–5

    Article  PubMed  CAS  Google Scholar 

  29. Pilepich M, 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: 616–23

    Article  PubMed  CAS  Google Scholar 

  30. Bolla M, Gonzalez D, Warde P, et al. Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Engl J Med 1997; 337: 295–300

    Article  PubMed  CAS  Google Scholar 

  31. Roach M III, Meehan S, Kroll S, et al. Radiotherapy for high grade clinically localized carcinoma of the prostate. J Urol 1996; 156: 1719–23

    Article  PubMed  Google Scholar 

  32. Dillioglugil O, Leibman BD, Kattan MW, et al. Comparative long-term outcomes after various management strategies for T1-2 prostate cancer: a hazard rate (HR) analysis [abstract]. Proc Am Urol Assn 1996; 155: 558

    Google Scholar 

  33. Chodak G, Thisted RA. Comparison of cancer specific survival (CSS) following radical prostatectomy (RP) or watchful waiting (WW) based on two multi-institutional pooled analyses [abstract]. Proc Am Urol Assn 1996; 155: 559

    Google Scholar 

  34. Yao S, Lu-Yao G. Survival following curative or conservative management in patients diagnosed with clinically localized prostate cancer [abstract]. Proc Am Soc Clin Oncol 1996; 15: 253

    Google Scholar 

  35. Wilt TJ, Brawer MK. The prostate cancer intervention versus observation trial (PIVOT). Oncology 1997; 11: 1133–9

    PubMed  CAS  Google Scholar 

  36. Petrovich Z, Lieskovsky G, Freeman J, et al. Surgery with adjuvant irradiation in patients with pathologic stage C adenocarcinoma of the prostate. Cancer 1996; 76: 1621–8

    Article  Google Scholar 

  37. Syndikus I, Pickles T, Kostashuk E, et al. Postoperative radiotherapy for stage pT3 carcinoma of the prostate: improved local control. J Urol 1996; 155: 1983–6

    Article  PubMed  CAS  Google Scholar 

  38. Fowler J, Pandey P, Seaver L, et al. Prostate specific antigen after gonadal androgen withdrawal and deferred flutamide treatment. J Urol 1995; 154: 448–53

    Article  PubMed  Google Scholar 

  39. Prostate Cancer Trialists’ Collaborative Group. Maximum androgen blockade in advanced prostate cancer: an overview of 22 randomized trials with 3283 deaths in 5710 patients. Lancet 1995; 346: 265–9

    Article  Google Scholar 

  40. Grossfeld GD, Small EJ, Carroll PR. Intermittent androgen deprivation for clinically localized prostate cancer: initial experience. Urology 1998; 51: 137–44

    Article  PubMed  CAS  Google Scholar 

  41. Higano CS, Ellis W, Russell K, et al. Intermittent androgen suppression with leuprolide and flutamide for prostate cancer: a pilot study. Urology 1996; 48: 800–4

    Article  PubMed  CAS  Google Scholar 

  42. 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: 235–46

    Article  Google Scholar 

  43. Small EJ, Srinivas S. The antiandrogen withdrawal syndrome: experience in a large cohort of unselected advanced prostate cancer patients. Cancer 1995; 76: 1428–34

    Article  PubMed  CAS  Google Scholar 

  44. Kelly WK, Scher HI, Mazumdar M. Prostate specific antigen as a measure of disease outcome in metastatic hormone refractory prostate cancer. J Clin Oncol 1993; 11: 607–15

    PubMed  CAS  Google Scholar 

  45. Figg WD, Sartor O, Cooper MR, et al. Prostate specific antigen decline following discontinuation of flutamide in patients with stage D2 prostate cancer. Am J Med 1995; 98: 412–4

    Article  PubMed  CAS  Google Scholar 

  46. Taplin ME, Bubley GJ, Shuster TD, et al. Androgen receptor mutations in metastatic androgen-independent prostate cancer. N Engl J Med 1995; 332: 1393–8

    Article  PubMed  CAS  Google Scholar 

  47. Small EJ, Carroll PR. Prostate specific antigen decline after Casodex withdrawal: evidence for an antiandrogen withdrawal syndrome. Urology 1994; 43: 408–10

    Article  PubMed  CAS  Google Scholar 

  48. Dawson N, Small EJ, Winer EP. Megestrol acetate (MA) in men with hormone-refractory prostate cancer (HRPC): prostate specific antigen (PSA) response and antiandrogen withdrawal (AAWD) data: a Cancer and Leukemia Group B study. Proc Am Soc Clin Oncol 1996; 15: 241

    Google Scholar 

  49. Kelly W, Curley T, Leibertz C, et al. Prospective evaluation of hydrocortisone and suramin in patients with androgen-inde-pendent prostate cancer. J Clin Oncol 1995; 13: 2208–13

    PubMed  CAS  Google Scholar 

  50. Small E, Baron A, Fippin L, et al. Ketoconazole retains activity in hormone refractory prostate cancer. J Urol 1997; 157: 1204–7

    Article  PubMed  CAS  Google Scholar 

  51. Eisenberger MA, Nelson WG. How much can we rely on the level of prostate-specific antigen as an end point for evaluation of clinical trials? A word of caution! J Natl Cancer Inst 1996; 88: 779–81

    Article  PubMed  CAS  Google Scholar 

  52. Figg W, Ammerman K, Patronas N, et al. Lack of correlation between prostate specific antigen and the presence of measurable soft tissue metastases in hormone refractory prostate cancer. Cancer Invest 1996; 14: 513–7

    Article  PubMed  CAS  Google Scholar 

  53. Pienta KJ, Redman B, Hussain M, et al. Phase II evaluation of oral estramustine and oral etoposide in hormone refractory adenocarcinoma of the prostate. J Clin Oncol 1994; 12: 2005–12

    PubMed  CAS  Google Scholar 

  54. Petrylak DP, Shelton G, Judge T, et al. Phase I trial of estramust-ine + docetaxel androgen-insensitive prostate cancer [abstract]. Proc Am Soc Clin Oncol 1997; 16: 310

    Google Scholar 

  55. Hudes GR, Nathan F, Khater C, et al. Phase II trial of 96-hour paclitaxel plus oral estramustine phosphate in metastatic hormone refractory prostate cancer. J Clin Oncol 1997; 15: 3156–63

    PubMed  CAS  Google Scholar 

  56. Kobayashi K, Vokes E, Vogelzang NV. Phase I study of suramin given by intermittent infusion without adaptive control in patients with advanced cancer. J Clin Oncol 1995; 13: 2196–207

    PubMed  CAS  Google Scholar 

  57. Reyno LE, Egorin MJ, Eisenberger MA, et al. Development and validation of a pharmacokinetically based fixed dosing scheme for suramin. J Clin Oncol 1995; 13: 2187–95

    PubMed  CAS  Google Scholar 

  58. Rosen P, Mendoza EF, Landaw EM, et al. Suramin in hormone refractory metastatic prostate cancer: a drug with limited efficacy. J Clin Oncol 1996; 14: 1626–36

    PubMed  CAS  Google Scholar 

  59. Small EJ, Marshall ME, Reyno L, et al. Superiority of suramin + hydrocortisone over placebo + hydrocortisone: results of a multi-center double-blind phase III study in patients with hormone refractory prostate cancer [abstract]. Proc Am Soc Clin Oncol 1998; 17: 308a

    Google Scholar 

  60. Tannock I, Osoba D, Stocker 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: 1756–64

    PubMed  CAS  Google Scholar 

  61. Kantoff P, Conoway M, Winer E, et al. Hydrocortisone with or without mitoxantrone in patients with hormone refractory prostate cancer: preliminary results from a prospective ran- domized Cancer and Leukemia Group B study [abstract]. Proc Am Soc Clin Oncol 1996; 15: 25

    Google Scholar 

  62. Small EJ, Srinivas S, Egan B, et al. Doxorubicin and dose-escalated cyclophosphamide with granulocyte colony-stimulating factor for the treatment of hormone resistant prostate cancer. J Clin Oncol 1996; 14: 1617–25

    PubMed  CAS  Google Scholar 

  63. Kim SI, Chen DC, Muggia FM. A new look at radionuclides therapy in metastatic disease of bone (review and prospects). Anticancer Res 1988; 8(4): 681–4

    PubMed  CAS  Google Scholar 

  64. Robinson RG, Blake GM, Preston DF, et al. Strontium-89: treatment results and kinetics in patients with painful metastatic prostate and breast cancer in bone. Radiographics 1989; 9(2): 271–81

    PubMed  CAS  Google Scholar 

  65. Laing AH, Ackery DM, Bayly RJ, et al. Strontium-89 chloride for pain palliation in prostatic skeletal malignancy. Br J Radiol 1991; 64(765): 816–22

    Article  PubMed  CAS  Google Scholar 

  66. Porter AT, McEwan AJ, Powe JE, et al. Results of a randomized phase-III trial to evaluate the efficacy of strontium-89 adjuvant to local field external beam irradiation in the management of endocrine resistant metastatic prostate cancer. Int J Radiat Oncol Biol Phys 1993; 25(5): 805–13

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. UCSF/Mount Zion Cancer Center, University of California, San Francisco, 2356 Sutter Street, San Francisco, California, 94115, USA

    Eric J. Small

Authors
  1. Eric J. Small
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Small, E.J. Prostate Cancer. Drugs & Aging 13, 71–81 (1998). https://doi.org/10.2165/00002512-199813010-00007

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-199813010-00007

Keywords

Search

Navigation