The number of men with Hormone Refractory Prostate Cancer (HRCP) is ever increasing; some statisticians feel that it could eventually become the most common cancer in the male population.
The clinical variability, the lack of consensus on patients’ eligibility for starting a different treatment, and the response criteria seen in literature have made it difficult to evaluate the impact of treatments designed for HRPC.
There seems to be a growing consensus among oncologists and researchers on defining HRCP. HRCP is defined as three consecutive PSA increases of more than 50% of the nadir level occurring at least 2 weeks apart and a confirmed castrated level of testosterone (< 50ng/ml). This should be assessed after withdrawal of the antiandrogen (AW) for at least 4-6 weeks.In reality this is not an adequate definition since second line hormonal treatments including Ketoconazole, aminoglutethimide, corticoids, and estrogens acting as adrenal steroidogenesis inhibitors do often induce a response in supposed HRCP. So, to say that the prostate cancer at this level is hormonally refractory is not accurate.I do agree, this sounds like an argument over semantics, but it is actually much more important. If we cannot, with agreement of all parties, accurately describe a disease state how can we progress on to developing better treatment paradigms?We need to come to consistent definitions, but these definitions and labels need to be accurate as to how they describe prostate cancer.Joel T Nowak, MA, MSW
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