Secondary hormonal manipulations in the management of advanced prostate cancer.

Prostate cancer is a heterogeneous disease and clinical outcomes vary considerably after failure of primary androgen ablation. With the development of new therapeutics the management of patients with androgen independent prostate cancer has changed considerably over the last few years. Multiple secondary hormonal manipulations are available and may lead to prolonged periods of clinical response. These maneuvers include the use of oral antiandrogens, antiandrogen withdrawal, ketoconazole, aminoglutethimide, corticosteroids and use of estrogenic compounds. This article reviews the clinical activity of these agents in management of patients with advanced prostate cancer.