Supplement Article Targeting the Androgen Receptor—Theory and Practice

Intensive investigation during the past 2 decades has led to an improved knowledge of the biology of the androgen receptor and a better understanding of how to assess for disease progression and the apparent existence of castrateresistant prostate cancer. The result has been the clinical development of a new generation of hormonal therapy agents for achieving the androgen deprivation necessary to achieve castrate levels of circulating testosterone. It has also resulted in the realization that it is probably time to move away from using terms such as “hormone-refractory” and “androgen-independent” prostate cancer, given the clear evidence that significant, effective, ongoing suppression of testosterone, using better drugs and better assays, will continue to be the standard of care. UROLOGY 78: S482–S484, 2011. © 2011 Elsevier Inc. F or nearly 7 decades, therapy that results in testosterone suppression in men with advanced prostate cancer has been known to be an effective management strategy. 1 During the past 20 years little has changed in the role and utility of primary androgen deprivation therapy (ADT) using medical or surgical castration. The combined androgen blockade debate has raged and subsided, given the real, but likely modest, effect on patient outcomes. 2 Before the prostate-specific antigen (PSA) era, men with prostate cancer were not uncommonly diagnosed when presenting with metastatic disease. ADT was typically initiated with an expectation of disease control for a period of 12-18 months. Clinical and/or symptomatic progression was typically the first indication of the development of hormone refractory/