Secondary hormonal manipulation.

Patients with advanced prostate cancer under primary androgen deprivation therapy will practically all develop progression, often associated with an asymptomatic increase in prostate-specific antigen. Recent reports are demonstrating an increased use of androgen deprivation therapy as primary or neoadjuvant treatment; however, meager clinical evidence supports the use of such treatment regimens for localized prostate cancer, except in patients with high-risk or locally advanced prostatic disease. Fortunately, the latter tumors might still be prone to some kind of secondary treatment to block androgen receptors in a primary, secondary or tertiary fashion. Secondary hormonal manipulations for affected patients include antiandrogen withdrawal, second-line antiandrogens, direct adrenal androgen inhibitors, estrogens and progestins. We discuss the emerging concept of secondary hormonal manipulation on the basis of the current literature and demonstrate prospective alternative treatment modalities.