The role of endocrine therapy in the management of local and distant recurrence of prostate cancer following radical prostatectomy or radiation therapy

Abstract

Those involved in prostate cancer treatment are often frustrated by the surfeit of careful comparative studies. This frustration is also true in the field of recurrent prostate cancer, where no randomized studies comparing competing treatment methods have been attempted. With an increasing number of men undergoing treatment of localized disease and more sensitive methods of detecting or predicting local failure, a large pool of men suffering failure after attempted cure will soon exist. If any firm conclusions are to be advanced in the management of recurrent prostate cancer, then large randomized comparative trials must be initiated now. New paradigms in thinking about prostate cancer must be developed in order to account for the advancements in prostate sciences in the past 10 years. Serially sectioning of radical prostatectomy specimens with whole-mount evaluation has disclosed an alarming rate of microscopic extraprostatic disease. The sensitivity of serum PSA in detecting microscopic locally recurrent disease has revolutionized the diagnosis of this stage of prostate cancer. Analysis of the DNA ploidy of tumors now provides new prognostic information apart from grade and stage of the primary lesion, and this technique should be used to stratify treatment groups whenever feasible. Carefully designed, multi-institutional studies would prospectively evaluate the benefit of early endocrine therapy versus delayed therapy versus radiation therapy in patients with the earliest stage of advanced prostate cancer--pathologic stage C2 or C3 disease. A prospective study of endocrine therapy versus radical prostatectomy and endocrine therapy should be attempted in patients with pathologic D1 prostate cancer.(ABSTRACT TRUNCATED AT 250 WORDS)