Hormone Refractory Prostate Cancer
hrpca.org: an excellent web site for HRPC patients; subscribe to its e-mail list: hrpca.org/onlinesupportlist.html
hrpca.org's page about chemotherapy: hrpca.org/chemotherapy.html

This site is for HRPC patients who want to be well-informed about HRPCa.

---Almost all files on this sites are PDF files that can be read with Adobe Reader. Hyperlinks in the PDF files are clickable, and the PDF files are searchable! Those files can be printed out as they appear on the screen: the very reason for choosing PDF files. Some of us, HRPC patients, dislike reading from a screen. They prefer reading a printout and PDFs yield the best printouts.  the contents of this site are not searchable by Google or other search engines

An increasing PSA while on primary hormonal therapy (LHRH + anti-androgens) indicates the beginning of HRPCa also known as AIPC: Androgen Independent Prostate Cancer. But the PSA can still be kept under contol by hormones other than androgens, e.g., estrogen and ketoconazole:  second-line or secondary hormonal therapy. HRPCa begins at failure of second-line hormonal therapy.

Treatment of  HRPC include chemotherapeutic and hormonal medicines, often combined.

Infusion chemo: 5-FU or 5-fluorouracil or fluorouracil, bevacizumab (Avastin), carboplatin, cisplatin, cyclophosphamide (Cytoxan), docetaxel (Taxotere), doxorubicin (Adriamycin), epirubicin (Ellence), etoposide or VP-16, gemcitabine (Gemzar), gefitinib (Iressa), mitoxantrone (Novantrone), paclitaxel (Taxol), vincristine, vinorelbine (Navelbine)

oral chemo: capecitabine (Xeloda, prodrug for 5-FU), cyclophosphamide (Cytoxan), (Satraplatin), etoposide or VP-16, gefitinib (Iressa), thalidomide (Thalomid), ca

hormonal: glucocorticoids: hydrocortisone, prednisone, dexamethasone (Decadron), estramustine (Emcyt), calcitriol, ocreotide (Sandostatin), tamoxifen, raloxifene (Evista)

other drugs: sargramostim aka gm-csf: granulocyte-macrophage colony stimulating factor (Leukine)(injecton), trastuzumab (Herceptin - infusion) and lapatinib (Tykerb - pill): EGF (epidermal growth factor) & HER2 inhbitors
see chemocare.com (Cleveland Clinic) for more information

B - overview articles (discussion of many treatments)
1.    -PDF-   Non-hormonal systemic therapy in men with hormone-refractory prostate cancer and metastases: a systematic review from the Cancer Care Ontario Program in Evidence-based Care's Genitourinary Cancer Disease Site Group. Eric Winquist et al., BMC Cancer. 2006 May 2;6:112. List of chemotherapy protocols for HRPC patients
2.    -PDF-  Chemotherapy for hormone-refractory prostate cancer. Mike Shelley et al. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD005247. A list of chemotherapy protocols - arranged per medication.
3.    -PDF-  Management of Advanced Prostate Cancer After First-Line Chemotherapy. D.R. Berthold et al. J Clin Oncol. 2005 Nov 10;23(32):8247-52.

C - specific treatments
1.   -PDF-  Is There a Role for Platinum Chemotherapy in the Treatment of Patients With Hormone-Refractory Prostate Cancer? - William K. Oh, Miah-Hiang Tay, and Jiaoti Huang, Cancer. 2007 Feb 1;109(3):477-86. Yes, there is. See also the following article.
2.   -PDF-  Phase II- study of Docetaxel, Estramustine Phosphate, and Carboplatin in Patients with HRPC - N. Kikuno et al., European Urology, v. 30 (2007)
3.   -PDF-  Effect of zoledronic acid on metastatic HRPCA resistant to Taxane, estramustine, carboplatin, and dexamethasone - N. Kikuno, Int. J. Urology, v. 14, 1, p. 82-84. Zometa was very effective in this anecdotal case.
4.   -PDF-  Phase II study of mitoxantrone and ketoconazole for hormone-refractory prostate cancer. Eklund J et al., Cancer. 2006 Jun 1;106(11):2459-65.  ....subjects were treated with mitoxantrone at a dose of 12 mg/m2 intravenously every 3 weeks plus continuous oral ketoconazole at a dose of 400 mg 3 times daily and ascorbic acid at a dose of 250 mg.  Mitoxantrone plus ketoconazole is well tolerated, is active in hormone-refractory prostate cancer, and should be studied further.
5.   -PDF-  Multicenter randomized phase II study of two schedules of docetaxel, estramustine, and prednisone (DEP) versus mitoxantrone plus prednisone (MP) - S. Oudard et al., J Clin Oncol. 2005 May 20;23(15):3343-51. Median time to PSA progression was five times longer with DEP than with MP (8.8 v 1.7 months). Overall survival was better in DEP (18.6 months) compared with MP (13.4 months).
6.   -PDF-  Phase II trial of gemcitabine, prednisone, and zoledronic acid in pretreated patients.. G. Di Lorenzo et al., J Clin Oncol. 2005 May 20;23(15):3343-51. Works for some.
7.   -PDF-  Overcoming Taxane Resistance in Metastatic Breast, E.A. Perez - Clinical Care Options  Abraxane (nanoparticle albumin-bound (nab) paclitaxel) has been approved for clinical use by the US Food and Drug Administration (FDA) in patients with metastatic breast cancer. Probably applicable to prostate cancer as well.
 

D - Potential treatments (not yet applied to patients)
1.   -PDF-  Potentiation of antitumour activity of docetaxel by combination with trastuzumab in a human prostate cancer xenograft model ... ME Legrier et al., Br J Cancer. 2007 Jan 29;96(2):269-76.  the docetaxel/trastuzumab combination may prove an effective therapeutic approach for HER2-expressing hormone-refractory prostate cancer.
2.   -PDF-  Low-dose metronomic daily cyclophosphamide and weekly tirapazamine... U Emmenegger et al., Cancer Res. 2006 Feb 1;66(3):1664-74
 

D - not directly relate to chemotherapy for HRPC patients
1.   -PDF-  High-risk localized prostate cancer: a case for early chemotherapy. Gleave M & Kelly WK, J Clin Oncol. 2005 Nov 10;23(32):8186-91