Update of hormonal treatment in cancer of the prostate

Prostate carcinomas are heterogenous tumors composed of hormone sensitive and hormone insensitive cells. Although all androgens have an effect on prostatic cells, it is believed that dihydrotestosterone (DHT) is the active metabolite primarily utilized by prostatic cancer cells for growth and division. Hormonal therapies are therefore designed to lower tissue levels of DHT or prevent its binding to receptors on prostatic cancer cells. The Veterans Administration Cooperative studies in the 1960s and 1970s laid the groundwork for the use and timing of hormonal therapy. Until recently orchiectomy and estrogens were the two main alternatives, but new compounds such as luteinizing hormone releasing hormone analogs and antiandrogens have shown to be as effective and less toxic than estrogens. Today, important controversies concerning the selection of the best primary treatment and the timing of initiating the hormonal therapy still exist. Second line hormonal strategies are used, but they still have to prove their impact on overall survival.