Treatment of hormone refractory prostate cancer

Prostate cancer is mainly an androgen sensitive disease. The use of androgen ablation can be dated back to Huggins in 1941. Currently patients with localized prostate cancer are managed aggressively and hormonal manipulations are reserved for locally advanced or metastatic disease. When androgen independence has emerged, treatment options are essentially palliative; with the aim of controlling symptoms and maintaining quality of life, and if possible prolonging survival. Following the failure of primary androgen ablation, a number of treatment strategies are available. Exploitation of the anti‐androgen withdrawal syndrome and using second or third line hormonal therapies are well established treatments. Interest in chemotherapy has been revived owing to demonstrable benefits in prostate‐specific antigen response and pain palliation, albeit without definite improvements in survival. An increased understanding of the molecular biology of prostate cancer has led to the identification of novel agents that may prolong survival while maintaining quality of life. Ongoing clinical trials are designed for assessment of these agents, with the view of adding them to our armamentarium against prostate cancer.