tailieunhanh - Chapter 091. Benign and Malignant Diseases of the Prostate (Part 10)

Metastatic Disease: Castrate Castration-resistant disease can manifest in many ways. For some it is a rise in PSA with no change in radiographs and no new symptoms. In others it is a rising PSA and progression in bone with or without symptoms of disease. Still others will show soft tissue disease with or without osseous metastases, and others have visceral spread. The prognosis, which is highly variable, can be predicted using nomograms designed for the castration-resistant disease state. The important point is that despite the failure of first-line hormone treatment, the majority of these tumors remain sensitive to second- and. | Chapter 091. Benign and Malignant Diseases of the Prostate Part 10 Metastatic Disease Castrate Castration-resistant disease can manifest in many ways. For some it is a rise in PSA with no change in radiographs and no new symptoms. In others it is a rising PSA and progression in bone with or without symptoms of disease. Still others will show soft tissue disease with or without osseous metastases and others have visceral spread. The prognosis which is highly variable can be predicted using nomograms designed for the castration-resistant disease state. The important point is that despite the failure of first-line hormone treatment the majority of these tumors remain sensitive to second- and third-line hormonal treatments. Castration resistance does not indicate that the tumor is hormone-refractory. The rising PSA is an indication of continued signaling through the androgen receptor axis. The manifestations of disease in this patient group hinder the assessment of drugs and treatment standards because traditional measures of outcome such as tumor regression do not apply. Bone scans can be inaccurate for assessing changes in osseous disease and no PSA-based outcome is a true surrogate for survival benefit. It is essential to define therapeutic objectives before initiating treatment as there are defined standards of care for different disease manifestations. Therapeutic objectives need not be defined by survival only as useful endpoints also include relief of symptoms and delay of metastases or new symptoms of disease. The management of patients with castrate metastatic disease requires first that the castrate status be documented. Patients receiving an antiandrogen alone whose serum testosterone levels are elevated should be treated first with a GnRH analogue or orchiectomy and observed for response. Patients on an antiandrogen in combination with a GnRH analogue should have the antiandrogen discontinued as 20 will respond to the selective discontinuation of the .