As I have discussed many times there is very little consensus about standard definitions or treatments for prostate cancer. Go to any doctor who supplies primary treatment and ask about their erectile or incontinence rates. Then ask them how they define those rates. The results will be all over the place with no consistency among them. What is a failure for one will be a success for another doctor.

You can also present different doctors with the same clinical presentation and depending upon the specialty of the doctor they will more often than not tell you that your best treatment is what they specialize.

There is no consistency in treatment recommendations or measures of success and failure.

Even defining hormone resistant prostate cancer (HRCP) is not agreed upon. Recently, there has begun to develop a consensus on defining when HRCP has developed. 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.Why is this important? It is important because HRCP signals the time to start a second line hormone blockade with Ketoconazole, aminoglutethimide, corticoids, and estrogens acting as adrenal steroidogenesis inhibitors that could induce a response in HRCP.In the alternative, chemotherapy with Docetaxel plus prednisone also induces a response. Some tumor prostatic cells may remain sensitive to small amounts of androgen products from the adrenal gland. Chemotherapy is introduced when there is a state of HRCP and the second line hormone therapy has failed.Joel T Nowak MA, MSW