For
this web site and for the support list we have chosen to use the term
"hormone-refractory prostate cancer" because it seems to be
the most commonly used designation for this stage of prostate cancer.
Dr.
Stephen Strum coined the term "androgen-independent prostate cancer,"
which he defines as follows:
"AIPC is defined as
disease progression evidenced by a progressively rising PSA (three
consecutive rises of at least 10% each or three rises that invovle
an increase of 50% over the nadir PSA) or an increase in tumor mass
on bone scan, X-ray, CT scan or MRI despite a castrate level of
testosterone (T<20 ng/dl)."
He further goes on
to say..."if
a patient’s PSA stops falling and begins to rise on ADT(2) or ADT(3),
if the T level is castrate, and if the adrenal androgen precursors
(DHEA-S and androstendione) are not low, then AIPC is presumed present
until proven otherwise. [Strum, S.B., "Important Principles
in Chemotherapy: Regimens Treating Androgen-Independent Prostate
Cancer," PCRI INSIGHTS, pp. 10-16, Vol. 2, No. 4, Dec. 1999.]
Note: this paragraph separates out the androgen receptor mutation
possibility and the resultant anti-androgen withdrawal effect
(declining PSA on stopping an anti-androgen.).
ADT(2)
is androgen deprivation therapy with an LHRH agonist and Casodex or
Eulexin. ADT(3) is the same plus Proscar. T is testosterone.
Dr.
Bob Leibowitz uses the term "hormone-resistant prostate cancer"
as follows:
"If,
in spite of a testosterone level in the castrate range, the PSA
is rising, then we define this as hormone resistant prostate cancer.
You might still respond to other hormone manipulations, such as
by adding an antiandrogen, if you were on monotherapy alone."
[http://www.prostatepointers.org/prostate/leibowitz/leib20.html]
Dr.
Leibowitz defines "hormone-refractory prostate cancer" as
follows:
"If
your PSA rises in spite of all hormone blocking agents (including
medicines like Nizoral, aminoglutethimide), then you have HRPC (hormone
refractory prostate cancer). Your disease may still respond to other
non-hormone treatments." [Ibid.]
In
the August 1999 issue of the "Prostate Forum" newsletter,
Dr. Charles Myers seems to use the terms hormone-resistant and hormone-refractory
interchangeably.
For
this web site, at the present time, we use the following working definition
of hormone-refractory to decide if an individual is eligible to join
the support group:
If
an individual has three consecutive increases in his PSA while on
hormone blockade, and his testosterone is at a castrate level (<20
ng/dl), we consider that he is hormone-refractory.
This
simplistic definition works because it is necessary to look at the treatments,
the PSA levels, and other tests to assess where he falls on the continuum
of partial to complete hormone-resistance. Usually it is a doctor who
has told the individual that he is hormone-refractory. Our first recommendation
to each of these individuals who joins our support group is that he
challenge the validity of that assessment by looking at past tests to
determine if the testosterone was indeed brought down to castrate levels
by the hormone therapy.
Since
there is a limited (but growing) number of therapies available following
hormone blockade, the important issue is to assess which of those therapies
are available for consideration by the individual and his doctor.
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