New developments in the medical management of prostate cancer

Abstract

Prostate cancer is a substantial public health burden and a leading cause of cancer-related morbidity and mortality in the United States despite the observation that annual prostate cancer-specific mortality rates have been declining during the previous decade. Although the reasons for this positive development are unclear, a combination of factors may have contributed. This update will review ongoing developments and summarize therapeutic advances in prostate cancer treatment on the basis of the current understanding of prostate cancer biology. Literature for this review was selected in 2009 by searching PubMed for the following keywords: prostatic neoplasms, castration, androgen receptor, hormonal, and chemotherapy. Emphasis is placed on published clinical studies in advanced prostate cancer therapeutics in the past 5 to 10 years. Also included in the review are novel hormonal agents targeting the androgen receptor currently in development for the treatment of advanced prostate cancer.

FIGURE.

Pathophysiological pathways and therapeutic targets in prostate cancer. ACTH = adrenocorticotropic hormone; AR = androgen receptor; DHT = dihydrotestosterone; GnRH = gonadotropin-releasing hormone; LH = luteinizing hormone; LHRH = luteinizing hormone—releasing hormone; PAP = prostate acid phosphatase. See glossary at end of article for expansion of all gene symbols.