Hormone-refractory prostate cancer and the skeleton

Abstract

Prostate cancer is the second most common cancer in men in the UK. Androgen ablation with luteinising hormone-releasing hormone agonists (LHRH agonists) alone, or in combination with anti-androgens is the standard treatment for men with metastatic prostate cancer. Unfortunately, despite maximal androgen blockade, most patients will go on to develop progressive disease after a variable period of time of 2-3 years. The management of hormone-refractory prostate cancer is challenging, as there is yet no uniform accepted strategy. In this thesis the comparitive efficacy of the two widely used palliative agents, 89Strontium and bisphosphonates in the management of hormone refractory prostate cancer is evaluated. Neither 89Strontium nor bisphosphonates have been so far shown to prolong survival, but our data do demonstrate that both agents have the potential to decrease the incidence of spinal cord compression and hence to significantly reduce the morbidity associated with this most severe skeletal complication of the late stage of prostate cancer. This potential may prove of importance in deciding which palliative treatment to use in hormone refractory prostate cancer, especially if patients have an increased risk for spinal cord compression or in patients with chemotherapy-refractory prostate cancer.