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New Paradigms in the Management of Hormone Refractory Disease

  • Chapter
Management of Prostate Cancer

Part of the book series: Current Clinical Urology ((CCU))

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Abstract

A paradigm is the philosophical and theoretical framework in which a scientific field formulates theories and approaches to questions. The traditional paradigm in prostate cancer has been that once a prostate cancer exhibits clinical hormone insensitivity, therapeutic interventions, especially chemotherapy, are of little benefit. This belief was supported by the disappointing and sobering experience with antiproliferative chemotherapy administered in a traditional manner (1). Recent discoveries, both in the clinic and laboratory, have changed the approach to the management of hormone refractory prostate cancer (HRPC). It has been demonstrated that prostate cancer cells grow slowly; this fact has tremendous impact on the design of clinical trials (2). Clinically, an increased appreciation of both the importance of quality of life and continued hormone responsiveness has led to substantial changes in the management of advanced prostate cancer (3). The use of palliative end points, prolonged oral chemotherapy, and combined chemohormonal therapy are examples of the new paradigm in the management of HRPC that are currently being applied in the clinic. However, another shift is also occurring. This involves the investigation of novel molecular mechanisms as targets of therapy. These processes include angiogenesis, metastasis, and differentiation. Therapies directed at these targets are still early in their development, but hold great promise for the future management of HRPC.

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Authors
  1. Jeffrey M. Kamradt
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  2. Kenneth J. Pienta
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Editors and Affiliations

  1. Section of Urologic Oncology, Department of Urology, Cleveland Clinic Foundation, Cleveland, OH, USA

    Eric A. Klein MD

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Kamradt, J.M., Pienta, K.J. (2000). New Paradigms in the Management of Hormone Refractory Disease. In: Klein, E.A. (eds) Management of Prostate Cancer. Current Clinical Urology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-714-7_16

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  • DOI: https://doi.org/10.1007/978-1-59259-714-7_16

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