The stable state is not an objective response in hormone-escaped carcinoma of prostate

Prostate cancer in the elderly

The incidence of prostate cancer is age related and increased longevity increases the number of elderly men with the disease. Management of prostate cancer in the elderly requires a different approach. Screening and aggressive case finding to seek out early confined disease are contraindicated in those with a life expectation below 10 years. Early confined disease in the elderly is usually managed expectantly. Hormone treatment is more appropriate for locally advanced disease, and is a valuable non-surgical treatment for bladder outflow obstruction due to prostate cancer. A significant proportion of elderly men with prostate cancer still die from other diseases. Hormone refractory disease in the elderly should be managed by palliation of symptoms rather than toxic second-line therapies. The aim always is diagnosis where appropriate, treatment which will be of benefit, and quality rather than length of life.

Early clinical experience with liarozole (Liazal) in patients with progressive prostate cancer

Liarozole (Liazal) is the first retinoic acid (RA) metabolism blocking agent (RAMBA) in clinical practice. RAMBA therapy promotes differentiation and inhibits proliferation by increasing endogenous RA in tumours. Liarozole was investigated in two open-label pilot studies of 100 patients with progressive prostate cancer in relapse despite previous androgen ablation. Liarozole (150-300 mg twice daily, for > or = 1 month) produced > or = 50% reduction in prostate specific antigen (PSA) serum levels in 15 of 30 evaluable patients in study 1 (50%) and 10 of 55 patients in study 2 (18%). PSA responders had more marked reductions in prostatic acid phosphatase, alkaline phosphatase and symptom scores for bone pain and urological symptoms, and improved general well being. Plasma levels of adrenal androgens did not alter during chronic treatment with liarozole nor at adrenocorticotrophic hormone (ACTH) stimulation test. Liarozole did not alter plasma levels of adrenal androgens or cortisol. Cortisol response to ACTH stimulation was slightly blunted. Liarozole was generally well tolerated. Dermatological adverse events were probably related to increased intracellular RA. Liarozole appears to be a promising treatment option in prostate cancer.

Prostate-specific Antigen and other Prognostic Factors in Patients with Hormone-resistant Prostatic Cancer Undergoing Experimental Treatment

In 58 patients with progressive hormone-resistant metastatic cancer of the prostate, prostate-specific antigen (PSA) greater than 100 micrograms/l, haemoglobin less than 12.0 g/dl and pronounced fatigue were found to be independent adverse prognostic factors. These risk factors distinguished a subgroup of patients with a median survival of 9 months (none or only 1 risk factor present) from a subgroup with a median survival of 4 months (greater than or equal to 2 risk factors present). The clinician should be reluctant to enter patients from the second group into complicated and resource-demanding clinical studies, particularly if such trials require frequent and inconvenient follow-up examinations.

Ketoconazole therapy for hormonally refractive metastatic prostate cancer

Twenty-two patients who had progressive metastatic prostatic carcinoma (Stage D2) despite androgen-deprivation therapy (bilateral orchiectomy, 10 cases; bilateral orchiectomy followed by diethylstilbestrol, 7 cases; diethylstilbestrol, 3 cases; combined megestrol acetate and low-dose estrogen, 2 cases) were treated with ketoconazole. Of 19 evaluable patients, 2 (11%) achieved a partial response (for 6 and 8 months) and 7 others (37%) achieved stabilization of disease (for periods of 3-8 months). Of 16 patients in whom pain was a prominent clinical feature, 13 (81%) noted improvement in pain for periods of one to eight months (median 3 months). We conclude that ketoconazole is a useful addition to our current armory for management of patients with metastatic prostatic cancer resistant to prior hormonal therapy.

Weekly low-dose adriamycin in hormone-resistant metastatic cancer of the prostate

Weekly intravenous doses of 20 mg Adriamycin were given to 22 patients with hormone-resistant metastatic cancer of the prostate. (Median duration treatment: 8 weeks; range 3-60 weeks.) Of 21 adequately treated patients, 6 achieved a subjective response (Median duration: 4 weeks; range 4-28 weeks). In 2 patients a more than 50% size reduction of measurable lymph node metastases was observed, while the disease progressed at other sites (mixed response). The median survival from treatment start (8.5 months) was unrelated to the achievement of subjective response. In 10 of 21 patients a reduction of serum alkaline phosphatase was observed and 7 of 21 patients showed a decrease of serum prostatic acid phosphatase. These biochemical changes were not related to response. Toxicity was generally mild, but one case with severe irreversible thrombocytopenia was observed after 3 weekly doses of 20 mg Adriamycin. Weekly low-dose Adriamycin has marginal subjective efficacy in progressing hormone resistant prostatic cancer, a condition where effective and feasible chemotherapy is lacking. The combination of weekly low-dose Adriamycin with other agents, preferably hormones, should be explored.