Hormone-Independent Prostate Cancer: Management of the Disease Continuum

Abstract

Neoplastic diseases of the prostate, both benign and malignant, are the result of or are associated with a sequence of genetic changes. While the sequence of these molecular events is under study, recent evidence suggests that both benign prostatic hyperplasias and malignancies of the prostate may be part of similar pathways. Currently, it is unclear if benign lesions are precursors of malignant change. The malignant spectrum also represents a continuum of disease, ranging from a clinically silent or latent form to palpable local lesions and ultimately to metastases. It is postulated that additional genetic alterations are associated with or required for further progression. In most patients these changes evolve over many years. As a result, there are many competing causes of death in addition to the tumour, particularly in elderly patients with localised lesions, and many patients die “with” as opposed to “from” the disease. Thus, a key to selecting the appropriate treatment for an individual patient, is to refine our ability to define the biological and clinical potential of a tumour.