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Year : 2008  |  Volume : 12  |  Issue : 4  |  Page : 15-27

Hormonal Treatment Of Prostate Cancer

Correspondence Address:
Prabirkumar Bandyopadhyay

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Source of Support: None, Conflict of Interest: None

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Prostate cancer has become the most common cancer of males in several developed countries. Prostate cancer is highest in western population, particularly among the black population of the United States. With widespread screening for prostate specific antigen (PSA) and digital rectal examination (DRE) as well as early treatment of localized prostate cancer, however, the age-adjusted rates of death due to prostate cancer have begun to decrease. Over 50 years since Huggins and Hodges first recognized the hormonal dependence of prostate cancer, androgen deprivation therapy (ADT) is the cornerstone treatment of advanced prostate cancer. Prostate cancer is the most sensitive of all hormone sensitive cancers to endocrine therapy. In addition to its well-established role in treating patients with metastatic disease, ADT is also used as adjunct the therapy for men undergoing radiation therapy for high-risk localized disease and in patients with increasing prostate-specific antigen (PSA) levels after local treatment even without radiographic or other evidence of metastatic disease. In the ear of PSA, more cancer are being identified at an early stage with 40-60% of them being localized at diagnosis, 30-40% being locally advanced and less than 5% with metastatic disease. There have been numerous changes in the management of prostate cancer over the last two decades. Consensus has not yet been reached on the best management for each stage of the disease. There is a strong rationale for the potential prevention of prostate cancer with hormonal therapy. Clinical states associated with androgen deficiency generally are associated with a lowered risk of prostate cancer. Neither benign prostatic hyperplasia nor prostate cancer has been reported in several kindreds of children born with variants of the 5a-reductase enzyme. Similarly, risk of prostate cancer is appreciably lower in individuals with cirrhosis and associated low levels of circulating androgens. Currently, there is little basis for determining which of the available androgen suppression treatments represents the best value. The costs and side effects of several antiandrogen therapies for advanced prostate cancer differ substantially.

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