Androgen-independent prostate cancer: not so chemorefractory after all.
Historically, hormone-refractory prostate cancer has not been routinely treated with chemotherapy, based on perceptions that single agents were not all that active, this patient population was too fragile to receive such therapy, responses were virtually impossible to verify given the rarity of bidimensionally measurable disease, and, if seen, responses were not clinically meaningful. The "truths" of the 1970s and 1980s are the "myths" of the 1990s, but unfortunately many physicians continue to propagate these myths despite accumulating data to the contrary. Newer combination regimens produce objective response rates in measurable disease that rival those seen in other solid tumors that are uniformly labeled as "chemosensitive." The widespread use of the serum prostate-specific antigen level has allowed the detection of progressive disease at an earlier stage in patients with an excellent performance status. Although chemotherapy to date has not had an impact on patient survival, quality of life analyses have clearly demonstrated improved palliation in treated patients. Hopefully, as this knowledge is disseminated more widely, more patients will be offered cytotoxic therapy for this currently undertreated disease.