Chemotherapy principles in the treatment of prostatic cancer.

Knyves I, Mntzing J, Rozencweig M.

Abstract
The efficacy of chemotherapy for prostatic cancer is difficult to evaluate owing to the low incidence of
measurable indicator lesions and the resulting need for indirect response criteria. Although complete
regressions remain exceptional, a number of agents, eg, doxorubicin and cisplatin have been shown to
be effective in the treatment of this disease. So far, combinations of effective agents with or without
concomitant hormone therapy have not proven to be more effective than single agents. Androgen priming
has considerable theoretical appeal and deserves further consideration. A higher effectiveness of
chemotherapeutic agents might be obtained by linkage to various carriers. Estramustine phosphate is an
example of such a complex that has a cytotoxic effect in test systems in which estrogen has no effect and
in patients with hormone-refractory prostatic cancer. The use of hormonal and other carriers that could
increase the specificity of chemotherapeutic agents deserves extensive exploration.

Non-hormone chemotherapy for prostate cancer: principles of
treatment and application to the testing of new drugs.
Raghavan D.
Author information
Abstract
Prostate cancer, one of the commonest malignancies in western society, remains a major challenge in
management. Although the typical patient is elderly and may not withstand aggressive approaches to
treatment, increasing numbers of our population survive to old age, while remaining healthy and active.
As prostate cancer is a disease of old age, it is therefore likely that there will be an increased requirement
to combat this disease in a fit patient population. Although hormonal manipulation provides effective first-
line treatment for 70%-80% of patients with metastatic disease, the majority of these ultimately relapse.
Cytotoxic chemotherapy has not provided a panacea for relapsed, hormone-resistant prostate cancer.
Despite the significant subjective and objective responses that can be achieved by the use of single
agents, the median survival of patients with hormone-resistant disease remains less than 12 months. The
use of combination cytotoxic regimens has not altered this. New approaches, perhaps including the
development of new cytotoxic agents, innovative uses of established drugs, or the application of the
biological response modifiers will be required before this problem is resolved. Until then, we must not be
satisfied with inadequate indices of success. The reporting of response rates and of survival statistics
drawn from the small group of responding patients is no true indicator of success. Until truly effective
treatment is available, we must learn to define more useful indicators of patient benefit, to be more
effective in palliating the symptoms of this disease, and to be more critical of the limitations of our
progress.

Survival advantage any characteristic that enables and individual to reproduce more effectively
than its competitors- refers to both micro- and macro- evolution